Well after an autumn break to see how the land takes up the fertiliser of restful thought, we approach the Christmas break with a need for reflection.

What has 2016 thrown at us?

A reason to be cheerful? A season of Goodwill? A sense of hope?

There are three major areas that seem to be affecting the profession at this time.

There is the issue of the GDC and its new Case Examiners.

It is too early to say if this will genuinely make a difference. What we want is for the GDC to stop trying to be a Complaints House, taking everything on no matter how trivial.

Dr Colin Campbell, a widely-respected colleague in the Midlands, with a personal history of the dealings of the bludgeon that is FtP, clearly thinks not – again with personal experience.

But then again, why would CEs make a difference? They have been tasked and trained by the very organisation that had the problem in the first place. And the problem is that the GDC do not reject anything.

Some of the recent cases suggest that the GDC still do not know what a proper complaint is. The whole list of FTP is awash with material that is either better managed locally and or indeed a simple internal disciplinary matter.

So, if you have not done so, get your £900 out for another year of outrageous wasteful use of your money. But do so with a good grace. It could be worse.

Couldn’t it?

Is it me or have we become so numb and subservient that we just accept it as a nuisance nowadays?

NHS Pilots – self funded by dentists!!

Meanwhile, perhaps all is well with new NHS Pilots. We all know there is new money, and we all know that the DH wants to get bodies through the doors, never mind whether anyone does any dentistry. But the idea of a Care Pathway appears to be well received on its own merits.

But there appears to be strange anomaly that the pilot practice may face up to 10% - YES TEN PERCENT – clawback – which if your profit is running at 20% reflects HALF THE PRACTICE PROFIT - which for most Pilot Principals suggests a cold winter looms.

Good on the BDA for highlighting this matter, on stage at the Local Dental Committees Officials Day , with the DH Head of Finance and the “fabulous” Dr Sara Hurley [You did see the Good Morning interview spat between our CDO for NHS England and Dr Tony Kilcoyne didn’t you?] sitting along side as Dr Henry laid into them in no undertain terms.

Indemnity in Crisis?

Maybe all is well with our support network, the Medical Indemnity Organisations. You know – Dental Protection, DDU, MDDUS and the newer companies such as Taylor Defence Services.

Well, who knows? There are stories of some colleagues finding their cover withdrawn in a discretionary manner halfway through a case. There are many stories of colleagues finding their annual cover suddenly approaching 5 figures and beyond. There is still no clear method for subscription calculation although one hears mutterings about the legendary ‘grid’. A sort of Spot the Ball for Indemnity subscriptions!

Whatever the truth, there is a financial crisis in Indemnity, driven by a combination of commercially proactive lawyers and an overzealous GDC. So much so that there is a one day crisis conference being held in January

After many discussions about rising Indemnity and concerns some colleagues have been left with no cover or representation etc., A 1-day Seminar is being organised by Dental Practice at the Hilton Metropole, Birmingham NEC, on Friday 27th January 2017 from 08.30 to 17.30pm.

Concerns are being expressed across the dental sector about the delivery of Professional Indemnity cover and what is and is not included in the various offerings from the MDO’s. As a result, and in conjunction with many key decision makers, it has been decided to hold this 1-day seminar to look at the current situation, with much time for Q&As.

Places will be limited and are expected to be in high demand so, to avoid being disappointed, contact Rodney Pitt, Editor and Conference Organiser at This email address is being protected from spambots. You need JavaScript enabled to view it.

Well that all makes for an energetic start to 2017.

It must be time for another letter to educate the public again, if the recernt rubbish written by Hunter Davies in the Times is anything to go by!

I suggest we all turn to our loved ones and count our blessings. In the year that we have lost Leonard Cohen, AA Gill and Greg Lake, we will not be short of words and music.

Put your practice to bed, and come back refreshed after a nod to the year, raring to go – unless of course you rely on Southern Railway in which case, the very best of luck!

If Christmas is your celebration, may yours be peaceful and joyful. That much we can be assured of

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The Chief Dental Officer for NHS England recently found herself at the forefront of dental media storm. Playfully referred to as “Recallgate” her reported comments drew widespread criticism across a range of the profession’s leading Clinicians, and a lame response through her PR Outlet, Dentistry Online.

All this arose from her presence at the NHS Expo on a stage with some leading colleagues of the Medical and allied professions for a question and answer session.

Expo is an interesting gathering of the great and the good from the world of the NHS and industry. The proudly proclaim

Health and Care Innovation Expo 2016 is a unique event that showcases innovation and celebrates the people who are changing the NHS, with high-profile speakers and a real focus on learning and sharing.

The NHS you’ll see at Expo on 7 and 8 September is a forward-thinking organisation, staffed by clinicians and managers who welcome innovations in technology and information because they recognise the difference this will make to their patients’ lives. Expo also welcomes and involves partners from across the public, voluntary and commercial sectors, recognising and promoting the role they play in keeping people and communities healthy.

Health and Care Innovation Expo attracts around 5,000 people across two days, the majority of whom are leaders and managers with real ability to lead and drive change in health and social care

So when the opportunity for Dr Hurley to speak, she chose to focus on one of the most exciting developments in dentistry.

The Recall Interval.

What she said of course was hardly earth moving.

Ration the availability of NHS dentistry for the healthy in order to create space in the system for those who are not healthy and have higher needs. This is hardly big news, is certainly not innovative, and of course was not presented as rationing by the back door. Instead it was reminder of the NIHCE Guidelines and an opportunity for some predictable side swiping at dentist.

In particular Roy Lilley made the really quite amusing quip that “Dentistry has become a rich man's hobby” The former NHS trust chairman Roy Lilley went on: “It has gone off the high street into lavish surroundings.”

Thanks Mr Lilley, if your understanding in depth of dentistry reflects your understanding of medicine, the NHS is safe in your hands. Oh, you are not a manager anymore?

You may follow Mr Lilley on Twitter at https://twitter.com/RoyLilley and contact him direct at @RoyLilley. Judging by his response to the leading BDA member Dr Eddie Crouch taking him to take, he only has a sense of humour on a public stage. Judging by his activity, he has given up NHS Management in favour of tweeting … 83,300 in 7½ years and counting!!

But look: there is a serious point here

Dentistry needs a Cheerleader

Mr Lilley is patently one of many self-appointed cheerleaders for the NHS and its achievements. Good on him. Nice money if you can get it

Dr Hurley had half a chance to really put out there what dentistry as a microbusiness, brimming with technology, can achieve for people. She could have even homed in on the Infant Caries crisis and its attendant GA costs. But no… she chose …. RECALLS!!

The media just loved her use of the MOT analogy and the Car Mechanic. If that is the case, I presume that Dr Hurley sees herself as in charge of Service Reception.

On a quiet news day, just feed the hacks a dental story. Works every time!

While smoking is on the decrease, and lifestyle amongst the healthy is improving, there is a section of the population who do not see a dentist and for whom Oral Cancer is a rising trend. If you are going to keep your teeth for 80+ years of adult life, getting the health of the mouth optimal and the habits established when young are critical.

What opportunity did we miss?

No mention of 3D CAD CAM Dental technology [self-invested by the laboratories and dentists – no Government subsidy there]

No mention of the investment dentist as business owners make in their facilities – no government subsidy there, and by and large no financial crisis inflated by excessive management layers.

No mention of the amazing results being offered to rehabilitate oral function using all-on-4 and all-on-6 techniques.

No mention of the amazing dental implant industry. Not a Government subsidy in sight.

No mention of the predictability of endodontics and periodontics being driven by technology of instrumentation and scientific understanding of the biology, and the ever stronger links to general health. Little Government input there.

No mention of the aesthetic desire of the wider public now being met by a host of non-invasive whitening systems allied to orthodontics. No Government funding there.

No mention of the unsung achievement of orthodontics in lifting the psychologic wellbeing of younger patients by creating the smile that allows a young person the mature into a confident go getting adult. OK some Government input here.

No mention of the parafunctional diagnosis meaning that dentist can frequently solve chronic pain issues long before the team of neurologists, physicians and chronic pain clinics with their MRI scans and raft of blood tests fail to diagnose and simply write the patient off to a lifetime of expensive medication.

No mention of the almost eliminated need to use mercury containing restorative materials nowadays.

No mention of the fact that Caries is preventable, and excessive sugar for infants is akin to smoking.f course no mention of all of this occurring painfree on nervous patients in one of the most difficult to access, most biologically hostile parts of the body. Diistinct lack of real funding here.

No, our CDO in her massive role on that stage at NHS Expo chose to ramble on about a 2-year recall.

We may think Mr Lilley is a “bit of a plonker Rodney” but dentistry needs someone like him.

Dentistry needs a cheerleader to shout our achievements from the roof top, and remind people that nearly all of them are self-funded by dentists and not subsidised by the government at all.

Sadly, Dr Hurley has missed her vocation in the role, choosing instead to follow her Civil Service guide on “How not to rock the boat”

I wonder if there is someone out there , possibly many of you, who could cheerlead our profession? Someone who, like Mr Roy Lilley, is so noisy, so irritating as to be impossible to ignore?

Please step forwards if you are those persons ...

So it’s down to you. Will YOU be the professions cheereleader?

Have YOU done your bit to cheerlead for our proud profession today?

If not, crack on. Our younger colleagues will depend on it in the future.

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Many of you demonstrate it in your daily work, by understanding what makes patients tick. They say one thing to you and you apply years of experience, so that after a few moments of reflection, you translate what the patient just said into a proposal for treatment with a couple of options. Our younger colleagues of course find this the hard bit of clinical practice, but with experience time and dedication all Dentists and DCPs in patient contact can become masters of this art.

At the other extreme, when it all goes wrong and some of our colleagues face GDC proceedings, the ability to reflect upon your circumstances is critical. The ability to show insight at the events that led to the GDC may be critical to a Panel taking a benevolent view.

Insight is an essential attribute for any dentist. For sure, lack of an ability to apply insight will often lead to trouble. It may compromise your relationship with your patient. You may finish up treating a patient despite the warning signs being there perhaps in the body language, or in the tone of voice used during a conversation.

Time?Not a lot of it about!

We recognise the application of insight as a skill and an attribute amongst our colleagues, and we admire those who have mastered the art of its use.

Of course the need to reflect and to gain insight require something that your NHS masters are reluctant to give you too much of: time

Even the GDC require time to reflect and gain insight.

So why is it that I think the top of the GDC may lack leadership, and the insight that is required to be effective?

There are at the GDC six Registrant members of the Council and numerous panel members who all, in their work and their practice have to find time to reflect and develop appropriate insight into their cases of regulatory work.

The Times - 6th August 2016

So it was with some surprise that the Chairman of the GDC, a certain Dr William Moyes PhD Esq, found himself demonstrating what seems to be a surprising ignoranceof the workings of NHS funded dentistry at the weekend, if The Times quote is to be believed.

Many of you will of course regard the summer as the season of slow news and will know that dentists are an easy target. If I were you I should take it as a compliment.

What never fails to amaze me though is how the media absolutely fail to gain any true understanding, insight dare I say, of the problems associated with the Government offering for the nations dental care

And so it was in last Saturday’s edition of The Times. Front page news no less. It was probably pure coincidence that the de Mello case was about to be started at the GDC. In fact, it was – a leading colleague single-handedly was trying to have the issue properly addressed. It is now behind a pay wall, but I have copied it below.

The Thunderer bellowed …

The article so nearly nails the issues, and in many respects it almost goes so far as to highlight “The Big Lie” and identify the lack of “Clarity of the Deal”. A big up to our colleague, Dr Kotari, for getting “High Street Dentistry” on the broadsheet agenda. Patently he did not write the copy.

The message was clear though. Even someone without deep insight into the NHS Dental Service can see it is trying to do too little for too many. There is only a certain amount of money, and the way it is spent simply does not allow for the provision of a broad range of highly complex procedures for everyone. There is a very good blog on the BDA site reflecting after this article by a young colleague Dr Robert Chaffe at https://bdaconnect.bda.org/bad-dental-press/ . The BDA through Dr Mick Armstrong were pretty robust in their reponse at https://www.bda.org/news-centre/press-releases/bda-response-to-the-times .

And as FtP numbers prove, the dentist’s lack of time to reflect and develop insight into the problems of a patient cause that patient to feel abused and make that first GDC contact.

It’s not a difficult loop to get your head around, is it Dr Moyes?

Clearly, it’s about clarity

Anyone with half a brain can see that the future must involve a clear demarcation of what is and what is not available as NHS treatment. The post-code lottery that is exemplified by the extraction -versus- endodontic treatment fiasco reveals the problem that everyone is shouting about. The only people who will not engage on this matter for no other reason than political fear are the dunderheads at the Department of Health. Even the BDA recognise that it will have to come - but everytime it is mentioned at DH or NHSE level senior officials shake their heads. "Can't be done dear chap".

UDA Targets are set by …

The message is equally clear about high levels of UDA targets – the dentists do not set these. The Local Area Teams do. In cases such as that of Dr de Mello, these colleagues may genuinely think they are doing the Governments dirty work for them in an efficient manner, bringing access to the masses at minimal cost. That is what the Government want, isn’t it? Dentistry is a broad church and while I would not poersonally be able to cope with a high UDA contract requirement, I know some can. Does that make them wrong in themnselves?

When I wonder will NHS management be called to account instead of the dentist who is the low hanging fruit of accountability?

What’s that you say? Never?

Soundbites

So when Dr Moyes, as GDC Chairman is reported in The Times as stating on behalf of the GDC, and I quote from the article:

The General Dental Council says that it cannot act because a lack of professional guidance allows dentists to claim that extraction is a legitimate option. “I’m sure that if patients had a full understanding they’d be quite appalled,” Bill Moyes, the council chairman, said.

What exactly can he mean? Is he saying there is a massive problem? Or is he demonstrating considerable ignorance similar to that which his infamous Pendlebury Lecture highlighted? Shall we assume Mr Chris Smyth, Times Health Editor, is including a quote relevant to the thrust of the article for now.

Can Dr Moyes really have so little insight into the working of dental practice? It certainly looks like it.

Did Dr Moyes not reflect upon the magnitude of the meaning of his comments? It certainly appears not. With that one comment Dr Moyes has revealed all that is wrong with his Chairmanship of the Council.

We now have a decent working team in the GDC Executive Leadership. But the Chairman has revealed that he is not neutral, and strategy driven. Instead, he appears to be a simple supporter of that broad-brush vox-pop opinion that “all dentists are trying it on”.

Last call for Dr Moyes…

The time has come for the Chairman of Council to shape up, learn about the long standing problems of NHS funding of dentistry and take on the causative Department of Health as part of the GDCs Strategic role.

Or he must step aside and let a more capable person take the role on.

It IS clear that it is time for Dr Moyes to reflect upon his position, for the sake of the profession he seeks to regulate and yet for which he patently has scant regard.

Regulators said that dentists were extracting teeth to avoid offering complex treatment, for which they are paid the same by the health service

Thousands of people are losing teeth needlessly because it is more lucrative for NHS dentists to take them out than try to save them, an investigation by The Times has found.

Regulators said that dentists were extracting teeth to avoid offering complex treatment, for which they are paid the same by the health service. The investigation has also found that some dentists earn almost £500,000 a year in a system that rewards them for cramming in as many patients as they can.

Dozens are claiming for the equivalent of more than 60 check-ups a day, in what has been condemned as an unethical conveyor-belt approach to patients. The upper limit is considered to be 30 a day for one dentist.

Under reforms introduced a decade ago, dentists are paid about £25 for every “unit of dental activity” (UDA) that they carry out. Each check-up, or simple examination, is classed as one UDA; tooth extractions count as three, along with fillings and root canal work, irrespective of how long the treatment takes. Root canal treatment usually lasts more than twice as long as an extraction.

NHS figures seen by The Times show that 30 dentists were paid for more than 15,000 UDAs last year — the equivalent of about 60 simple appointments a day over a standard working week. Ten dentists were paid for more than 18,000 UDAs, equivalent to about £450,000.

Alex Wild, of the TaxPayers’ Alliance, a public spending watchdog, said: “The amount of work dentists do will obviously vary significantly, but the figures at the top end appear totally implausible . . . an urgent review is essential.”

Dentists routinely weigh up how much time and treatment a patient needs against a desire to maximise earnings, say professional leaders who concede that the payment system is causing an “ethical compromise”.

The warning comes before the disciplinary hearing next week of the dentist responsible for the biggest patient alert in NHS history. More than 20,000 people treated by Desmond D’Mello, 62, were called for HIV and hepatitis testing after he allegedly failed to change gloves or clean equipment between appointments in an attempt to see as many patients as possible.

Mike Waplington, president of the British Endodontic Society of root canal specialists, said that extractions had jumped by a fifth and root canal treatment had fallen by almost half after the contract that paid the same for both was introduced in 2006. Root canal treatment could take three times as long as an extraction. “There is an incentive from the system and some dentists may say to patients ‘I can take this tooth out simply’.”

More than two million teeth were taken out on the NHS last year, but Mr Waplington said that many could have been saved, estimating “over the lifetime of the contract it would have affected tens of thousands of teeth”.

Many dentists also feel more comfortable taking teeth out, as only 277 out of more than 40,000 are registered as specialists in root canal work.

Trevor Lamb, co-founder of the Saving Teeth Awareness Campaign, said: “The public are too quick to accept that teeth should be removed. They are unaware of the alternatives and some dentists exploit this. You wouldn’t go into A&E with a broken arm and expect it to be amputated.”

At least 2,000 dentists claimed for more than 8,000 UDAs, equivalent to the upper limit of about 30 check-ups a day. Neel Kothari, a Cambridgeshire dentist seeking reforms, said that it was difficult to do more “in any ethical sense”, with 60 patients a day impossible without cutting corners.

He warned that dentists intent on maximising income might skimp on treatment as well as hygiene. “It’s as if you went to a top restaurant and they served you a Big Mac disguised as a gourmet burger,” he said.

Nigel Carter, chief executive of the Oral Health Foundation, said: “To do a proper assessment of the patient would probably take 20 minutes. But that hasn’t been what the health service has been paying for. There is a bit of an ethical compromise.”

The General Dental Council says that it cannot act because a lack of professional guidance allows dentists to claim that extraction is a legitimate option. “I’m sure that if patients had a full understanding they’d be quite appalled,” Bill Moyes, the council chairman, said.

A spokesman for the Department of Health said that a new contract was being tested, adding: “If a dentist was found to be needlessly removing teeth this would be a matter for the General Dental Council.”

Sir, Your report and editorial suggest that dentists can claim as many UDAs as they like. On the old system, dentists could earn more by carrying out more treatment, and the annual dental budget could only be estimated. The current contract was designed to allow a budget to be set in advance. Each dentist is contracted to carry out a certain number of UDAs a year. If a dentist exceeds the number of UDAs contracted to them they get no additional pay. If they fail to complete the contracted number, their fees are clawed back. The dentists have to tender for contracts each year. Whose fault is it if dentists are paid for a large number of UDAs? However, to claim that the upper limit of patients is 30 per day is unrealistic. In the 1990s I used to work with three staffed surgeries and treated 70 to 80 patients a day. That would equate to more than 30,000 UDAs a year. On a four-day week, I hardly ever ran late.

Copyright

Finally the GDC have issued a small puff of white smoke from their chimney in Wimpole Street.

After much personal hard work by our colleague Dr Vicky Holden, and an uncertain amount of work by our representative body at the other end of Wimpole Street, the Council of the GDC voted to remove all address details from their on line register. 60,000 mainly female DCPs will I suspect be mightily relieved. 20,000 odd female dentists will rest a little easier.

If you have not been on the end of unwanted attention, it can be many things. Embarrassing … alarming … irritating … flattering … laughable … but worst of all of course is when it becomes frightening … perhaps even sinister.

Many of us will have had nurse as employees who find themselves on the receiving end of unwanted attention from some admirer- in-waiting. Some of us may have even had to step in on occasion

How the previous CEO of the GDC even thought there was any justification in the first place remains a mystery. But then the workings of the previous CEO were a mystery of course.

Our patients are entitled to know we are registered. In fact 99% of them assume we are.

Perhaps we should put our GDC Number on all correspondence … estimates, invoices, letters etc. I know many do. It’s not a secret.

But it is right that patients with ulterior motives should not be able to pursue an alternative and unwanted agenda.

So hats off to our GDC. Of course you might ask why the Council did not do this 2 years ago when it still scorchingly obvious to anyone with half a brain that the matter needed addressing, so to speak.

The Council

This episode suggests that the new senior executive management at the GDC are quite different. There is a sense that their agenda may well be one we could subscribe to.

But perhaps this whole ‘address’ saga says more about the Council. It was those 12 Members, 6 of whom are Registrants, who ducked the issue 2 years ago.

It rather confirms in my mind that we have a better Executive in place at the GDC but we still lack a strong Council who will do the right thing at the right time.

Ah yes ... that brings me to ‘ole Billy boy. The Old Guard still sitting in that position at the middle of the table I see. Still writing twaddle-blogs!

Good job he has been able to keep his address secret all these last few years what with all the FtP debacle!! Perhaps we can look forward to a new method addressing Dr Moyes in the near future: The Former Chairman … Then we might see some real changes.

So…
Two weeks after our vote, give or take and it has been an interesting period to put it mildly.
If you voted Leave, it has been quite hard to lean on the positive, but that is changing. The FTSE 100 is back up, the ‘250 is trailing but improving, and while the Pound has taken a hit, many would argue that has been a trend waiting to happen. Despite Mr Osborne using this week as an excuse to drop his 2020 Deficit promise, the fact is he was a million miles off the mark BEFORE the vote. And then there are the personalities and the power broking.

Non, je ne regrette rien
As a GDP who voted ‘Leave’, do I have regrets? No. Perhaps in future, politicians will take their people seriously instead of overriding our worries with their ‘we know best’ soft speak.
Viz, Mr Cameron, who failed to take Referendum matter seriously enough to have a plan in place, it appears. Similarly, I am surprised to say, the Leave leadership who I suspect were as surprised as the PM that the vote went 52%:48%
I did suggest that it would be a revolution and I do think that is exactly what has happened. About time too, many might suggest.

So what has changed?
Nothing, in the next two years and in reality some greater time than that actually changes. We remain in the EU bound by EU Treaties and Law, making our payments and presumably supplying our MEPs
Now call me cynical.
No sooner had the count been completed than the EU declared that Mr Cameron’s ‘EU Deal’ negotiated in February was declared invalid and was withdrawn! So much for the EU being on Mr Cameron’s side.
Is it me? The EU cannot wait to be shot of us anyway. They have been waiting for this to happen for years.
Where were the ‘Remain’ MEPs during the Referendum campaign? Where were the EU Officials, doing a Grand Tour to report what they the EU does do for us? Quite.
Of course, there has been a huge amount of posturing, and superior sounding comment made by all parties. But the dust is slowly starting to settle and realpolitik is starting to become the accepted wisdom.
The chase for the top job in the Tory party is underway; surely a Brexiteer has to take the job?

The outlook for Labour is unclear as I write this, it appearing that Mr Corbyn feels he does not need the Parliamentary Labour Party on board for him to have another go at winning the leadership.
Just when we need a strong Opposition, they decide to go to the beach!!

A mandate for change, or a vote for planning change?
Now there is a valid point that only 38% of the Electorate voted Leave. There is widespread concern about the Union, given Scotland’s quite specific vote to remain. There is the Irish matter of how to handle and nurture the peace, allied to the thinning border.
It is all very well to say ‘” We voted exit” but accepting that logic recognises that any way forwards has to take account of the 62% of the Electorate who did not vote or voted Remain, it has to take account of Scotland, and it has to take account of Ireland.

That is not a circle that needs squaring – that is a complex multi axis movement joint with a multitude of ways to be set, and this needs arranging BEFORE Article 50 can be invoked. An inclusive approach by the next PM will be critical.

It is my opinion that the result of the referendum, being notable but NOT a mandate, is only a start to such a process, and we are simply not there yet.

It is my opinion that Mr Cameron was mistaken not to create some strong ground rules for the Referendum, in particular to the nature of the need for a vote of in excess of 50% of the Electorate. In any other Committee the world over, that vote was inconclusive enough for the Chairman [ie Mr Cameron] to place his casting vote for the ante status quo.
Burt what is done has been done. What should not happen now is that there should be a rush to make more political mistakes.

Better preparation, and a proper mandate
Despite what has been suggested only today [Sunday 3rd] by Mrs May, there must surely be a General Election to restock Parliament with MPs based upon a final Leave or Remain campaign, before Article 50 can justifiably be invoked. I say that as someone who voted Leave.
The biggest challenge now is for a leader of quality to unite the country in its way forwards. If Mrs Theresa May is the bookies favourite, and given Tory party leadership campaign history of old, Mrs Andrea Leadsom is a likely bet.
These are by all measure the most extraordinary times in which we live.

Hi ho, Hi ho, it's off to work we go ...
And yet tomorrow, we all go off and drill, fill and bill. Nothing changes, except the mood and the strangely opaque vacuum that is the political parties we see around us.
If the past two weeks have been a Political revolution, we must be careful not to cause a Geographic revolution by poor leadership and ill thought out ways forwards.
The leadership elections various at least buy everyone some time, despite what our huffy and impatient EU Leaders might suggest.
The summer vacations could not come at a better time, to allow everyone to take a deep breath.
Leave? What, now? No, in about 3 years time - perhaps even at the 2020 Election time?

http://audiovisual.europarl.europa.eu/Page.aspx?id=2885
MEPs call for swift Brexit
Top Story - 28-06-2016
Official visit of the President of the European Parliament in London. A general view of the EPIO London, Europe House on June 18, 2015 where the President of the European Parliament Martin SCHULZ today visited and gave interviews with selected journalists. UK-European Flags

Copyright

As a GDP I am really struggling to focus on what my vote should be. So I have set myself the task of reading across the campaigns this weekend.

It’s a busy week, and you too need to do your final reading. If only this was vCPD eh?

Well why not? It’s clear that this affects your dental practice, so go reading, message me privately and I will send you a simple feedback document, and a certificate for vCPD. Allow 2 hours.

What is they say about a divorce? You must have a reason to go and a reason to leave.

Do we? Have we?

Here are your links for the Remain and Leave campaigns [also knon as the “Innit” and “Exit” !] and other information sources or repute. If you read over these there will be lots of facts, and a degree of balance. I have tried to avoid opinion.

EXIT If at the end of this, you vote for the UK to exit, you will be lighting the fuse for the first cannon shot in a bloodless revolution.

No less, no more. The aftermath will be a change in the political landscape of the UK not seen for centuries. Make no mistake, in the past, civil conflinct started over less.

REMAIN If we vote to stay in, we will have the same group of leading politicians weakened by the arguments in the campaign, but a stronger case for lead influence in Brussels. Perhaps a vote to remain is a vote for change we do not expect?

Is the GDC a sort of Beaurocratic Supertanker, steering a steady, slow path to its chosen destination, slow to change direction and similarly hard to stop?

Or is it akin to a Bull in a China Shop? – breaking everything it touches in an out of control display of unnecessary strength?

You decide.

There have been a number of recent high profile GDC cases which have caught the eye of any casual observer.

By far the highest profile, in terms of reflective blogging and reporting, is that of Dr Colin Campbell, a colleague who has a practice and training facility which offers implants as a special interest and is generally regarded as being state of the art and second to none. As good as you can get. If you have not read his reflections on his experience at the receiving end of the GDC systems, I have linked them below. It makes painful, perhaps stimulating reading.

You will I am sure be left with one driving question.

Why?

Why does one case drive such a vindictive, damaging process?

There was another case which was even more worrying: This case of a colleague in the south west went all the way to an FtP hearing before the Panel finally nailed it with ‘No Misconduct Found’. In this case there was NO patient complaint – it was the Charity, the “Good Thinking Society”, founded and led by journalist Simon Singh, who contacted the GDC based upon a web trawl. Having discovered concerns with some web site material, the Charity chose NOT to contact the practice at all.

But then again, neither did the GDC who took it all the way to a Hearing… at a cost of about £200,000 all in [Registrants costs, GDC costs etc]. The case revolved around some web site wording which was changed before the process truly got under way, after a request from the GDC!!

You will I am sure be left with one driving question.

Why?

How can some contentious wording on a web site, which can be changed overnight, where NO patient has been involved, and where NO attempt at local and direct resolution has been attempted, possibly justify a full hearing?

What is in it for the GDC ? Justification of their work and justification of their ARF Fee?

These are not cases which need ‘the law changing’ to avoid being taken so far. S60 orders have nothing to do with this fiasco.

This is pure vindictive incompetence.

It is a regime of Regulation by Fear. At a team level, the GDC do engage, and apparently learn, and we must be grateful that the PR teams of the GDC do come out and meet and greet.

But despite all that hard work, we continue hear the dulcet tones of the limp rag of leadership that is Dr Moyes, and still the Bull rages in the FtP China Shop. Still we see NO evidence of proper oversight by the Council. Still we see the Registrant members of the Council taking their expenses.

Why?

It’s perhaps a reflection perhaps of the mind-set of the GDC in the past, and their reluctance to act in any way which might be regarded as agile or rapidly adaptive, that still we have no specialisation for implantology.

We continue to see quite extraordinary cases heading out to an FtP hearing based on dubious investigative methods and a sense that the charges are trumped up come what may to try and make some mud up, let alone make it stick. There is a sub-genre of course of expert witnesses who have questions to answer in this respect.

The case of a retired Orthodontist and a single patient, with his long spat with the 'establishment' has become so embroiled that the 5 days of the initial hearing proved insufficient, and an adjournment was taken. For what possible benefit?

But most important you will I am sure be left with one driving question. Why?

Dr Colin Campbell of course took an unwittng starring role in Manchester last week

It’s a [Conference] Wrap

If you are a member of the BDA you may well have heard from the dentists present at the recent Manchester Conference that Dr Campbell’s presentation pretty much stole the show. It is also fair to suggest that Alistair Burt MP, the Health Minister certainly spoke eloquently the necessary words in respect of the scandal that is Infant Dental Prevention, and the scandal that is GA Admissions. Finally, of course the FGDP are coming of age, and in particular engaging down in the mud with us wet fingered souls, and re-publishing their guidance on Record Keeping, which will be Open Source. That is a very welcome move, Sirs. The GDC of course is off limits for a Minister.

Which will happen first? NHS Change or GDC change?

If one has to speculate, I reckon we will still be talking in 6 years [when the ‘Newish Prototype Contract Version x ’ emerges] about child dental treatment & prevention as funded by the Government because there is no more money to deal with these matters.

Whereas, I suspect that the passionate and motivated colleagues in self-funded dental practice who are feeling the cold hand of the GDC will be effective in their lobbying for significant change.

The GDC will change. How and when is to be decided.

No one objects to the idea of a regulator for the industry that is dentistry. It is the quite surreal high cost, psychologically, professionally, financially, and in time terms of the blunt instrument that is FtP, allied an unaccountable Interim Orders Committee that is objectionable.

It is the idea that the GDC are a first line Complaints Handling Agency.

It is the idea that all dentists are out to harm their patients and lessons must be public, humiliating and disproportionate.

The salt on the professional wounds is, in case after case, Dr Campbell’s being but one, and our colleague in the Southwest who fell victim to the dubious Charity The “Good Thinking Society” being another, where the GDC blankly refuse, or have wilfully chosen not to, force any complainant to seek local resolution first.

That is a choice the GDC make. Why?

Do they do that because they truly believe a £200,000 process cost is a better and more efficient form of justice? Or they do that because they are incompetent and simply have no idea how to be frugal with the resources placed at their disposal by Dentists and DCPs in the form of the ARF?

The New Team

So… it’s the end of the season, and there is new management in place. It’s not just in the national game that management is brutally changed!

Mr Brack’s first job as substantive CEO at the GDC is clear – stop feeding the monster. Sedate the Bull. Perhaps after the events of a US Zoo at the weekend, shoot the beast dead.

Perhaps … stop FtP until it is reconfigured?

Stop the Bull wrecking the china shop.

So as we head for the ARF setting for 2017, what has changed? We have a new Chief Executive in Mr Brack. And a new Director of FtP in Mr Green. And old hand in the shape of Dr Moyes. These three have the future of dental regulation in their hands. Dr Moyes having proved reluctant to grasp the mettle with his Council team, so it must be Mr Brack, in partnership with Mr Green.

That’s it.

So no pressure gentlemen. The survival of your organisation and Dental Regulation as we know it depends on you calming this raging beast that is FtP, and it looks doubtful that your Council will be much help.

The clock is ticking and many professional eyes are on you. Indeed, some are still weeping from the whipping that presently is FtP

Copyright

Motivation is funny old thing. What is that makes you get up and go to work? In amongst the demands of family life, most of us have to insert some productive hours to generate income to fund the lifestyle of our choice. So be it. But dark winters, both meteorologically and professional with persistent bad news, take their toll.

So as the days lengthen, the earth continuing to tilt on its axis, and the temperatures rise, notwithstanding the unusual nature of May snow !] you feel the burdens of winter lifting. So let the sun warm your face and raise your spirits. It makes a change from rust and frostbite!

May and its adjacent months are the period of Dental Shows, and Conferences. The Dentistry Show in Birmingham, an acclaimed success, despite the fact that only 5% of the registrant population attend. Then the BDA Conference in Manchester takes place at the end of May and the LDC Conference 2 weeks later, in Manchester too. The Scots LDC Conference took place at the end of April.

These events are a chance to catch up, network with colleagues, and begin to feel good about your profession. Feel the draw of the latest technologies and equipment, dream, perhaps plan, the next big step in your professional life.

It’s not too late to drop into the BDA Conference and call your Representatives to account. 130 Sessions over 3 days. The link is below. Manchester in May? Blazing sunshine, darling. If you have not been, give it some thought. Motivate yourself.

Forgiveness is motivating ?

Motivation in its widest sense might mean, for example, that past misdemeanours of our lead regulator fade into a forgiving memory. Sadly recent events mean I cannot avoid mention our old muckers, the "Wimpole Street Stasi".

Spare a thought for the situation of our colleague Dr David Lee, whose wellbeing and reputation have been unnecessarily tested to breaking point by an FtP Hearing at the GDC which was not just thrown out, but was found so wanting that there was NO CASE TO ANSWER. In other words the GDC simply drove an FtP case on a spurious basis. I urge you to read the hearing while you can, and gasp in anger and sympathy that such events can even be commenced, let alone taken to this £1/4M expensive debacle.

The GDC Chairman, Dr William Moyes, has only last week had the gall to stand up at the Scottish LDCs meeting [linked here to a GDPUK thread] and state that he is not resigning because, in essence he is part of “The Solution”. So much for accountability for his Councils distinct lack of proper oversight.

Dr Moyes may be part of some perverse Final Solution but I am not sure that is part of what he has in mind.

For me and my colleagues such as Dr Keith Hayes it is a motivating feeling to think that Dr Moyes is still in post and still does not get it. Time for a Spring clean?

So does motivation really increases your capacity to forgive or does it merely allow you to feel justified in moving on in respect of matters about which, in truth, you can do little?

“Whatever, no worries” becomes your daily Gallic shrug. It’s sunny and the days are long, do I care?

Good job really if you are NHS funded.... Read on ...

Lost you way? You’re not the only ones…

The perils of the all new, singing and dancing Government computerised support in the form of Compass is just ‘one of those things’. Oh for a paper FP17 – oh wait they have changed them, slotted in some extra data collection but failed to print them in time. Online advice on their filling-in is there – but no FP17 other than a sample version! So use the old ones for now – which Compass of course cannot process properly!

The stories of struggles with Compass are now becoming more than irritating – it is beginning to feel like the software has not been properly specified and it may, if the present shambles is anything to go be, be at least one financial year before all the errors and omissions are corrected. Indeed, Compass and its pointed failures have been a feature a long thread on GDP UK recently if you have not read it.

Meanwhile, if you are spinning your Compass to see which way it points, Good Luck! You are not alone… This was a Government Spring Clean which does not appear to have worked well.

CQC – Motivating better regulation

On the other hand, compliance is never an easy activity. Let’s face it we are all dragged to the altar screaming. The CQC, in particular now they have Dr John Milne in a leading role, barely a year after his Chair of the BDAs GDPC ceased, are actually evolving fast and well and now leading the future of Regulation in the wider sense.

Not only are their processes actually evolving fast and being targeted where needed, but they are dragging all the regulatory participants to the table to sort out who does what.

You can take part – so go to the links and get your say in. It will make you feel better. The CQC are looking increasingly like an effective strategic ally of the Dental Profession, with scope to act where the Professional Services Authority [PSA] lack the teeth.

Now that feels better!!

The weather? Yeah, motivating, isn’t it?

Good job everything else in life is a motivating force for good.

It seems that some of the leading agencies upon which we depend could do with a Spring Clean.

Copyright

Welcome back. I think Easter if officially over, just watch the traffic next week!

Your regulator, the GDC, is trying make the news again. Perhaps in that ironic respect, it is very successful. I suggest the smell is not good.

However, perhaps not in in the way it might be hoped. The GDC is spinning the facts to serve its own interest. Again.

You remember the GDC?

It’s that organisation for whom you pay the best part of £900 per year as a work tax. If your business also funds your staff registration, you will be paying well over £1000 per year.

It’s that organisation, paid for by you, that squanders money on frippery and self-serving PR, accountancy consultation and £9M building expenditure. Prudent management of other people’s money is not part of its remit, it would seem. Your money is used in part for its role as a World Class Complaints Agency [remember all those outrageous FtP cases? … they are still coming through!].

Seconds away … Round 4 - Dentistry versus the GDC

It is the latest bleating of the Chairman that should catch your eye and stir your loins with a sense of disbelief and injustice. It certainly has for the BDA [ are you a member - £30 a month for the fighting fund, get on with it!] who have returned to the ring for another fight. We can but hope that Big Mick is aiming to knock over Chairman Bill and obtain the final ‘fall’.

If you have not taken great interest so far, I am sorry to lean on you again, but please – without YOU taking a simple action, nothing will happen.

As a wet fingered GDP, you CAN make a difference.

The BDA alone cannot clean the stable on your behalf. The smell and the excrement remain, and it “All hands to the brooms”

Why all the fuss?

You will, I hope, have noted the PSA Report before Christmas.

Finally some three months later Dr Moyes, Chairman of the GDC sticks his head over the parapet. Writing in his Blog, you could take a rosy view of the world in Wimpole Street. This Blog is seemingly the first of many. Boy, I look forward to those … the excitement is too great.

I suggest to you that these are the words of a professionally dying man. If you read the minutes of the 3 March 2016 GDC Meeting, to which Dr Moyes makes reference, it is clear that the Executive Management Team [EMT] of the GDC have been explicitly humiliated so that the Council can remain in post.

What's the problem? This is the problem:

The Council of the GDC have completely washed their hands of any responsibility.

There is no mention anywhere of the failed oversight of the Council

The Council have abjectly failed and yet remain in complete denial.

The Council have been explicitly criticised to an unprecedented level by external bodies from the PSA to Parliament, and yet they hold their heads in the air singing “La La La”.

The BDA are to be congratulated for shovelling more coal on the fire, but I think more is needed yet.

If you know a Council Member, ask them why they have not resigned? If you know of them, write to them and ask them the question.

What "Point of Principle" causes them to stay?

Dr Moyes may think he has got away with it but I think we must all prove him wrong. So very, very wrong.

Until this Council are forced to resign en-masse, nothing will change because it was Dr Moyes and his merry band of Members that oversaw the woeful actions of Ms Gilvarrie, and it is the GDC Council which will design the Job Spec for the new CEO.

If you mix your cake with a poisoned spoon, the cake will always be poisoned.

The GDC have fallen - The political referees should end it now

The Council of the GDC should resign. The Chairman should already have gone. It is an amazing arrogance of unholy magnitude that he and they have not.

Whom should be first?

It is clear the Chairman has the skin of a rhino and so it is down to the Council to consider their positions based upon the principle of what is right.

Your profession needs your help. Support the BDA. Write to your MP. Write to the Registrant members of the Council. Phone people.

JUST DO SOMETHING

DO NOT BE SILENT.

There is a sense that the BDA have started the final round. You need to shout and holler’ your support.

Copyright

In my last blog, I noted a developing Critical Mass for change in how we address infant caries and its consequences. And barely a month later, the steam pressure has been increased once again.

The Chief Dental Officer Dr Sarah Hurley, is starting to make public inroads into her role, and recently delivered the 2016 Pendlebury Lecture. It was in stark contrast to the one delivered in 2014, demonstrating a wide understanding of the playing field that is dental health.

Critical Mass 2

It comes at the end of a week in which the state of children’s teeth once again was publicly pilloried, on the back of the General Anaesthetic numbers.

While it remains a problem in England, just look at Scotland. After many decades when Scotland has been spiritual home of the UKs dental problems, it suddenly produces numbers through its Child Smile initiative that suggests significant inroads are being made to improve the health of children’s teeth and prevent dental caries [and thereby reduce the costs and morbidity of unrestricted dental breakdown]. It is not really rocket science, they have just been investing in infant dental health.

So we in England [and Wales and Northern Ireland to a similar extent, but out with the CDO[NHSE]’s remit] have a problem.

We know the target population for any changes must now be parents and infants in equal measure. There seems to be ample evidence that parking the dental professionals in discrete buildings, called Dental Surgeries, is simply not working, and it is evidence that Dr Hurley seeks.

We know that the medical stakeholders are now on board, as obesity and diabetes rear their heads with all the long term cost implications. Indeed it is the medical drive for a sugar tax to discourage the dietary shortcomings that is also driving the publicity that emerged in the Daily Telegraph over the weekend of the 26th February, and was subsequently widely discussed on broadcast and printed media.

Follow the money

So increasingly the priority is being defined. But the thorny issue will arise of funding.

Which Departments will pay? How will we [the public] pay for the inevitable targeted measures that are due to follow, as day follows night? A sugar tax undoubtedly could easily raise the funds but the political will in the chaos pre-Referendum is clearly not there.

There is a serious danger in the current fiscal period of restraint that the HM Treasury will insist on a cost neutral option. Maybe not, but we must for now assume that.

Could it be that the GDP Budget is being eyeballed [at £3.4Bn] as the low hanging fruit of funding that could or perhaps should be used to address the issue of infant dental health?

The Chief Dental Officer is clearly leading dental health to a better place – but who will pay for this Piper’s plans?

The role must soon change it seems to that of Chief Decision Officer.

Interesting times, but the sooner we address the issue of Dental Health for the young child, the sooner we can restore some pride to our profession.

As a GDP you would do well to plan for big changes. Not sure what but for sure very significant.

· Since 2011, all elements have been delivered in all Health Board areas throughout Scotland.

· "As a result of our efforts, dental health in Scotland is improving, particularly in deprived communities. In the Primary 7 age group dental health has never been better and on a Scotland level the target of 60 per cent of this age group having no obvious decay has been met. This is a fantastic success story."

There is a concept in nuclear chemistry which many will be familiar with. Critical Mass has been adapted to apply almost any situation nowadays. When a process of change is beginning, Critical Mass is used to refer to that point when change becomes inevitable.

What starts as a mood that change is needed becomes a minority activity with early adopters, eventually tipping over the edge for widespread general change for the better.

The bigger the system, the more one can see change with necessary Critical Mass at work on a daily basis

Early Years - has General Dental Practice failed?

Is “Early Years” dentistry about to undergo a change of massive significance? Is the state of children’s teeth [as it relates to caries and GA Admissions] about to trigger a political Critical Mass change

The problem of course is this:

£3billion of funding, give or take, by the Government, aims at funding dentists to sit there waiting for patients to wheel their little rug-rats in for a ‘check-up’.

Sadly, two facts suggest this time-honoured approach is a fail.

Firstly only 50% of the population actually go to the dentist, and that is without weighting the numbers towards any problems with new migrant or ethnic groups.

Secondly, by the time the child appears for their check-up age 3-4, the caries is already established, the dietary patterns are embedded and the Prevention horse has, by and large, well and truly bolted.

My back-of-my-vape-packet estimate is that some £73Million is spent [in England alone] with hospitals sorting out the fact that community prevention of dental disease in children has failed. The medics have now woken up to the fact that this same diet is leading to an epidemic of child obesity and diabetes.

This pressure for change, smouldering for some time, arguably gathered pace with the excellent planning document, Delivering better oral health: an evidence-based toolkit for prevention at

Patently dental teams who care for caries affected early-years-children do their best, often with imaginative and innovative outreach, but the numbers for GA Admissions suggest the problems fires are still raging despite the attempts to limit the spread by the profession from the GDP model.

Is the demand for planning of a different dental intervention for the first three years beginning to gather momentum? Are we indeed reaching a point where the energy and desire for change to be planned means that significant change will indeed become a priority?

Just look at the last year of public domain comment and criticism of the present status.

The Sugar-Obesity-Diabetes-Caries complex

Sugar is now being discussed in a widespread public debate about obesity [be it child or adult] and diabetes but led his time our medical colleagues. Caries is being discussed too.

Dentistry was the subject of an adjournment debate in the House of Commons this last week

Various media events [including the 3rd Daily Telegraph Letter] have taken place in which members of the profession have presented the view that the present system of delivery of dental care is simply failing to deliver any effective prevention to the early-years child.

It is also unclear if the new GDP Pilots will change much in the context of a developing problem and reducing financial resources in Government spending plan. It is clear the new CDO [NHSE] has sensed this and is trying to wind the initial changes back and see where the true problem lies an th evidence takes her.

Evidence?

Sadly, there is no real evidence, because we have a problem which requires action for which an integrated approach has never been trialled, let alone undertaken.

One example of the media attention is a recent BBC Look North slot with Dr Tony Kilcoyne. The BDA it is reported are meeting with the Chief Medical Officer’s team.

Dentistry on its own is a small backwater of medical provision.

But when we start to get frequent interventions by the medical profession, increasing interest by the broadcast media, and an increasing public desire to understand and discuss the situation as it relates to THEIR dental health and that of their children, … well anything can happen.

Now what happens to the GDP’s element of the NHS Budget on the back of such changes is, of course, a separate discussion.

But can all this really happen? Will we really witness 2016 as the year that Critical Mass for real change will be reached.

Dentistry and Medicine united?

I suggest the need for a “National Early Years Preventive Strategy” will be crafted which integrates medicine and dental care into a program targeted at mothers and their children and wider families that will aim to influence the diet and dental care of the under 3’s.

We as a profession have arguing this case for years and the Department of Heath have merely sat by.

I sense the medical profession are not going to sit idly by and watch the sugar/obesity/diabetes/caries scanal wreak further havoc, be it to personal heath or their budgets.

We can but hope.

We can hope that as a profession we are included in the delivery of a solution.

We can but hope that something better comes out of it for the wider work of Geneal Dental Practice.

This is of course the third year that such a letter has been published by, this time, some 400 signatories including this writer. Critically, a small nugget of self-opinionated idealism say some. By contrast its supporters suggest it is merely a further reasoned cry for a sensible strategy to use the limited Government money for the groups in need. For example, those such as children who finish up in theatre under a GA, or other high needs groups, often postcode affected.

Just where is the Clarity of the Deal for the rest of us for example?

However, is there a Conspiracy of Silence? Perhaps a mood of disdain? For as we speak some 3 weeks later, the BDA have not mentioned its publication. At all. Anywhere. You may search their News Releases at https://www.bda.org/news-centre/.

Would you care to wonder WHY the BDA feel so reluctant to even acknowledge the letter let along jump on the brief media bandwagon? Complacency or Conspiracy? You choose.

The PSA-GDC relationship

It is certainly a case of no love lost. Before Christmas, you will recall, the GDC were aligned in the crosshairs of the PSA and their hyper critical report.

Comment made again on GDP UK and elsewhere has been withering. It is clear that there is a mood that the Chair of the GDC must go, not just because of these events, but also BEFORE any process to identify a new Chief Executive takes place.

It is therefore very interesting that the GDC have seen it unnecessary to mention in their public media releases anything about this report, let alone any sort of “It’s all good here” spun response.

I have stated it before. Others have stated it. And so we all say, again:

The Chairman must go, and the Council, in particular the Dental Registrant Members of the GDC, should seriously consider their position.

The BDA

Shortly before Christmas , before the letter in the D Tel, the BDA seniors figures and the LDCs met with the new CDO of NHS England, Dr Sarah Hurley and you may read the reports here courtesy of Yorkshire’s East Riding LDC

Is it me? It is similarly interesting to think that since then the BDA have kept a very tightly sealed pair of public lips on matters pertaining to the disgraced UDA system of Contracting and its Prototype successor

Not a mention, not a dicky bird.

Complacency or Conspiracy? You choose.

There is it might be argued a fine line between complacency and conspiracy as to why each of these bodies [The BDA and the GDC] have chosen to ignore these two unrelated and yet significant events.

Which leaves me to ponder the conspiratorial nature of the relationship between the GDPC of the BDA [representing all you dentists at the negotiating table for the New 2020 Contracts] and NHS England’s Chief Dental Officer.

It seems like the old days, for those of you old enough to recall that great old wise owl, Labour leader and Prime Minister Harold Wilson. Beer and sandwiches at No 10. In this case, filter coffee and homemade biscuits with a fine group of colleagues.

Transparency is dead.

Complacency is the food of conspiracy

The outcome is the same. It appears any chance of truly driving change with the wider interests of the public and profession at heart, in a transparent manner, at the highest level of our Profession, is to be denied.

Instead agreements will be cobbled together in secrecy and behind closed doors by the privileged few. You will told when you need to know

As was stated recently: we are a Profession that suffers Group Mural Dyslexia ! Failure to see the writing on the wall.

A little more energy is required if we are to see the Profession make progress against the political headwinds this year.

Perhaps a little less complacency and a little more Conspiring to rebel? We can but hope!

It is the season of Goodwill to all Men [and Women of course]. Too much food, a touch too much liquid spirit, and comfy armchair beckon for many, while Granny sups the sherry.

It is a time of year to reconnect with family, and let loose the strings of attachment with dentistry.

It has been quite a year. If anyone has recently been affected by the extreme weather and flooding, you will have our deepest sympathy and best wishes.

TWTYTW

We have a new CDO[NHS England] who seems to have big dreams. While her grip on reality is yet to be proven, her grip on mission creep is patently in doubt too as the New NHS Contract slides back another year. When does evidence seeking become procrastination I wonder?

Let’s not forget to toast the former CDO [NHS England] spinning the revolving door of Corporate employment. A nice little earner, some might cynically say; I could not possibly comment. For sure, the numbers-merchants all seem in agreement. Corporate Dentistry is a House of Cards just waiting for the crutches to be kicked away.

What about our soon-to-be ex-Chief Executive Officer of that great body in Wimpole Street. I wonder how many cards of goodwill she really will receive? Goodwill to Dental Colleagues has been the byword on her watch… NOT!

And then of course our congratulations to the newly elected members of the BDAs Principal Executive Committee. Is it me or is a vote of 1900 on a membership of 18000 a 10% turnout? Is a 10% turnout the sign of a well engaged campaign and a profession with fire in their belly? Hmmm, thought as much.

So there is much to be done and as ever so little time to do it.

Crystal balls, anyone?

Maybe 2016 will be the year that as a profession of 100,000 like-minded souls we unite into one influential body, instead of Nurses here, Therapists there, Dental Technicians under the table, Dentists arguing and never agreeing, LDCs bangin’ on to no avail, the BDA in constant denial and the FGDP worrying about ‘stuff’. No wonder the Government can run rings around us all.

To you all, I bid you a Happy Christmas and an Utterly-Butterly Joyful New Year.

In the South, we Sassenachs favour the early celebration. North of the border of course, our Scots colleagues will be awaiting the excesses of Hogmanay. To our non-Christian colleagues, we know you will join us in celebration in whatever way suits.

But wait:

What is this with Santa’s paw prints all over it? A PSA Report I see? Now this is a Festive card of gargantuan size.

Ladies and gentlemen of the Dental Profession, now you know why the Chief Executive Officer and Registrar of the GDC has pulled the Ejection Seat firing handle and is departing.

This is a 270 Page report on the investigation into the General Dental Council’s handling of a whistleblower’s disclosure about the Investigating Committee dated 21 December 2015, but from events through the previous 3 years.

My goodness me. I take it all back. The PSA do have teeth, they are most certainly sharp and their Regulatory jaws have closed around the neck of the GDC.

Close typed pages of absolute dynamite. Evidence based critical analysis of what the GDC did with your ARF that led to it having to be increased...A pantomime with an unbelievable plot by any other description.

Please do go read it Ladies and Gentlemen. 2016 may indeed be “The Year”

Many would say she was right all along. How sad it has taken this long to prove it

Broadsword calling Billy Boy … Broadsword calling Billy Boy

Dr Moyes? Are you reading this… You know what you should do. Prove to us that you are the honourable and ethical Gentleman we believe you to be.

As should the whole Council, given the implications of poor oversight.

Pull up the table, You get the mulled wine, I’ll get the nibbles. Just feast on these nuggets of you will.

6. Overall conclusions

What was the outcome of the failings in the Investigating Committee processes and support during 2013?

6.1 The outcome was that the independence (and perceptions about the independence) of the GDC’s Investigating Committee were jeopardised by various practices that were designed to improve the quality and consistency of the Investigating Committee’s decision making, but which at the same time sought to restrict the Committee’s autonomy to an extent that infringed upon the appropriate separation of powers within a regulator. This could have had very serious implications for the GDC in terms of the robustness of decision making, potential judicial review actions and the consequent reputational damage. Those practices also had serious implications for the culture that developed in the Investigating Committee Secretariat, which in turn affected the working relationships between some Investigating Committee members and the Secretariat team.

6.2 “ Changes had been made to the reasoning of Investigating Committee decision documents after the event and without appropriate authorisation … “

6.14 …”The Chief Executive is ultimately accountable for the decisions taken about the level of information disclosed to the GDC’s committees and the Council, staff and GDC associates. The Chief Executive also had several opportunities to identify the seriousness of the problems emerging, even if they were not properly brought to their attention.”

And finally

Sub note 257, with my highlighting of the PSA final words in the Report. Hah! Pass that English Sparkling Wine, dear - the one that knocks spots off Champagne ...

Here's to 2016 dear colleagues.

“257 We note that the Chief Executive has responded to our conclusion by stating that they believe that they acted appropriately and quickly in response to each risk as soon as it became apparent, and that they reported fairly and fully to the Audit/Audit and Risk Committee and the Council. The Chief Executive has stated to us that their view is that they have responded to each of the “shocks” that have occurred to the GDC with honesty and transparency and by taking appropriate action. In response to seeing a draft of this report the GDC has said that the Chief Executive’s reliance upon the former Director of Regulation was reasonable, has noted that the Authority’s 2012/13 performance review of the GDC did not identify problems relating to the Investigating Committee, and has referred to the fact that no complaints had been made by the Investigating Committee members, and has drawn the conclusion that the Chief Executive could not have had visibility of the problems emerging in these circumstances.

Copyright

The BDA claims to be your representative body and the Principal Executive Committee is its leadership board. It is elected by you, if you are a member.

Are you one of the 18000 odd BDA members who have heard the distant thud of voting papers landing on your mat? Have you read the Candidates Statements? You may read them here https://www.bda.org/pecelections

If you have waded through them, you may be forgiven for wondering if the candidates have been reading the dental news!

While I admire the concept of leading the profession, and for sure Mick Lad is slapping few heads, I do worry that this reflects an assumed position of strength that is perhaps not wholly justified.

For starters, who will lead the 22000 other odd dentists [a greater number, no less] and who will lead the DCP’s – some 60000? So representing 18000 to “lead” a profession of 100,000 is in my book, bordering on spin of political magnitude. Never mind, move on.

Are the candidates REALLY in touch at your level, at my level? Do they really understand the wet fingered challenges we face?

The news I referred to of course is regarding our old muckers, Cruella and Billy Boy. If their divorce is well signalled in advance, the ARF announcement must be their parting gift to all their friends. How sweet.

BARF

I cannot refer to our annual Practice Tax without using an expletive as the first word. Many years ago, in student days, such a word would suggest advanced post alcoholic nausea. Sadly, I can see a startling similarity nowadays!

In case you missed it. it was serenely announced that the relentless march of arrogant loftiness continued as the GDC, without hint or irony or guilt, agreed to maintain its role as the most expensive [and arguably useless] Regulator in the UK. Proud and passionate, Premier League stuff – indeed with the ARF at this level they should be able to afford a truly gifted player soon, so swollen will be their Reserves.

“Dr William” has become curmudgeonly friendly “Bill” again as he seeks to avoid the need to spend more time with his family.

Saying “it may be patients who suffer as a result of the GDC’s actions”

PECking Elections

So it is an opportune time [voting closes 14th December 2015] to see if the mood of the BDA Leadership will truly reflect the outside mood of anger.

I am struck that of the 22 candidates, many have issued look-back statements of their achievements, and simply assumed that will be good enough.

Indeed, what a fine profession we have and the contribution that these colleagues have made over the years to the profession of dentistry and the wider community simply cannot be overstated. Please take note Mr Hunt.

They are truly amazing and we should salute them.

But I was also struck by the fact that of the 22 National Candidates to lead the profession, only 8 made any real mention of the GDC.

We can but hope that Dr Armstrong welcomes some proactive colleagues to the Principal Executive Committee if his lead of the fight against the GDC is to carry any momentum in 2016

Your vote counts

At the moment, in the proper voting sense, the Jury is very definitely out.

If the BDA and its PEC are to be an effective representative body, I think the second year of a near £900 ARF suggests that they need to play harder, and kick more accurately. They are 2-0 down and this election suggests that members had better vote carefully if the match is not to be a whitewash.

A wise BDA with its eye on the ball would aim its actions at the other 80000 non members as well, that being the biggest investment in future membership and the wellbeing of the profession that can be achieved.

Copyright

So… we learnt today that the Chief Executive and Registrar of the GDC is to step aside. What is it you hear said? The longer the name of the job … Hmmm.

By all means have fun deciding whether she jumped or was pushed. Enjoy heating the invisible ink in order to read between the lines of the Press Releases. Savour if you will the exchange of pleasantries between the Chairman, Dr Moyes and Ms Gilvarry which suggest that there may have been little love lost.

Is it me or was there an undertone of glorious victory from the Chairman? A bijou hint of “OK that’s over, let’s move on”.

What now?

The problems with the GDC remain three fold

The financial aspect.

The GDC seem to assume that the funding of the ARF can be an unlimited remit, a bottomless pit of registrant’s cash. Nowhere in the Strategic Plan, for example [being celebrated rather rudely by Dr Moyes in almost the same sentence as his “goodbye wave” to the CEO] is the concept raised of budget cuts, or reduction of budget.

Indeed at the Dental Complaints Service, a reduction in complaints is seen as a crisis needing management to bring the numbers back up by advertising. Only an arrogant Quango could possibly see things this way.

This of course is in the context of department cuts and harsh realities of reducing public funds.

The sense of aloofness and insulation from the realities of the world mark the GDC out. They arrogantly march on ignoring the realities of day to day financial life for the dentists.

Unless the new CEO comes in with a wholly different attitude I see little chance of change. It is the Council and the Chairman who will design the ‘essential skills’ matrix. It is they who will determine the job requirement.

The Council and The Chairman must now, of necessity, come under immediate and decisive pressure from the profession.

The regulatory aspect.

The problems of the GDC are in simple terms their reluctance to recognise and classify complaints properly at the early stages. FtP and the appalling costs are driven by too many single patient complaints, in which over-zealous Expert Witnesses [colleagues by any other name] encourage the GDC legal teams to generate charge lists which if they were not so serious for the Registrant, would read like a copy of the Beano. Lets remember: the present CEO has been in cahoots with the Chairman to create a Complaints Handling Agency - a far cry from an efficient regulator with its eye on patient safety.

Proper classification of incoming complaints does not need a Section 60 order – this needs a CEO to understand Dentistry. Only if our new CEO understands Dentistry will we stand a chance of having a CEO who understands a Dental Complaint. Only then can a CEO classify at the early stage complaints which should be managed out of the GDC and those which are truly FtP matters.

Unless the new CEO brings a wholly different level of dental knowledge I see little chance of change. The Council and the Chairman will design the ‘essential skills’ matrix.

I say again: The Council and The Chairman must now, of necessity, come under immediate and decisive pressure from the profession.

The unresolved business.

Can we expect a new CEO to take a different view on the matter of publication of addresses? Can we expect true transparency and full public domain records for Interim Orders? Can we expect a reduction in ARF? Can we expect it to be become permissible to employ nurses out with the over-priced and over burdensome system of registration?

A skirmish, maybe, but there is more

It seems to me that the resignation of the Ms Gilvarry may be regarded as a decisive moment.

But the problem remains the Council and their Chairman. Six of those are Registrants.

Now is the time for them to consider their true loyalties as they write up the Job Specification for the new CEO.

Wow, imagine of the six registrant members were now to tender their own resignations in order to effect complete change at the GDC?

Copyright

The early autumn is a period of wind and rain, perhaps storms and even the back end of the Atlantic hurricanes. All in all it is often a period of wild weather.

I wonder if dentistry is entering its own Autumn of storms and wild and windy conditions.

Can we hope even for a “fall” of sorts, in Wimpole Street; you know, a “Fall from Grace?” Perhaps near that newly refurbished office block at No 37?

I dream. It’s too much to hope.

Let’s look at the facts.

West Side Story

The BDA [at No 64, being on the West side of the street] are suddenly in a ballot kind of frame of mind, openly calling for such a move. [1] OK it is only the hospital based colleagues but they have tagged along with the BMA on the proposed changing of the working week to include the weekend.

Now if the Government, broadly, get away with this, anyone fancy betting it will trickle into GDP in the new contract?

Meanwhile the GDC have attracted Dr Mick’s ire – again - as they feel the need to start examining how to measure the quality of YOUR dental care. The GDC ? Yes, you heard right. [2]

GDC Metrication is on the way to YOUR practice

In the GDC’s Big Plan for the Next 3 Years they suggest: [3]

Patients:

Objective 3:

To increase the information we provide to help patients make better informed judgments about their treatment

Over the next three years we will do the following to meet this objective:

improve our online register and website so that patients can find out more information about their dental professional, including how to locate a specialist.

explore the development of quality metrics in dentistry so that patients are clear about the quality of the care that they can expect to receive.

produce a range of guidance for patients and their carers about what they can expect from a visit to a dental professional and what questions they could ask. We will tailor this guidance to the type of treatment and the setting where care is provided.

Now if you thought the CQC slid under the radar of professional alertness, or that the GDC being reorganised to emaciate the dental involvement by having a Lay majority and non dental ‘appointed ‘ Chairman was one you really should have seen coming, I urge the assembled throng to finally take this one seriously

The GDC are expanding into the quality of YOUR care

It’s not the only area the GDC plan to expand. They even plan to expand the role of the Dental Complaints Service. [3]

They are on record as wanting to advertise again because the numbers of complaints are dropping!!

Yes, you heard right. Oh, and they see the NHS as a major partner, not as the creator of the UDA nightmare that drives people to the GDC in the first place! [3]

The awakening of the sleeping… Giant?

However, there is a faint sense that the BDA might, possibly, finally, be awakening to the possibility of a long and hard fight against Government sponsored attacks on the profession. We are of course in good company with our medical colleagues.

If Press Releases are the tip of the “what’s going on behind the scenes” iceberg, perhaps all is better that we had thought?

If you are a BDA Member – phone them and find out what their plans are.

If you are an FGDP member, phone them too!

You, on your own, can do little. Only as a united front can we even remotely stand our ground.

Or are we going to sleepwalk into yet another costly restriction upon our activity ?

Search And Rescue? [SAR]

As if all that is not enough, in a separate move reminiscent of Cold War Eastern Europe, the GDC are under fire for retaining data on all public discussion about its efficiencies, filing such data against the name of the registrant. [4]

There has been an eye opening thread on GDPUK [no doubt all carefully annotated and filed by the GDCs very own MI5 trained clerks].

If you have not made your Subject Access Request to the GDC you are most definitely urged so to do.

Do you know what data they hold about YOU?
Do you know the justification?
Give it some thought.

How Snoopy laughed! ARF ARF!

It's that time of the year again. The GDC are now consulting on next year’s ARF. After 37 pages of "transparency", it was hard to remember that they were proposing ‘no change’. Still, I always like to see out money being used wisely.[5] [6] [7]

The new NHS Contract is dragging on [as predicted] and there is a sense that the current financial crisis surrounding NHS Trusts generally must at some point trickle down into the provision of dental care. Cuts have to be in the shadows, even if they are not overt.

So all in all, a delightful Indian Summer of calm? I rather think not!

No Sir. The storms are brewing and I suggest that you had better batten down the hatches.

Far from clipping its wings, the GDC is very much in an expansionist frame of mind and YOU ARE PAYING FOR IT.

And when the Government pay you LESS through the new contract to do MORE, we will all pay, sadly, in so many ways.

And who will be the ultimate loser? The poor patient. Your patient. My patient. And perhaps all those who are not patients.

Perhaps now is the time for the profession to start uniting in some way?

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There was a time when those of use of a certain age [OK Old if you will, but take that tone out of your voice!] decided to pursue dentistry for many reasons one of which was the life time career of care which happened to be comfortably paid. Professional life was stable, practice management was an ongoing process. Interestingly by and large we saw all the patients who wanted to be seen and managed their dental needs without any political calls for damage limitation of a crisis of “Access”. Those of us so inclined went home for a celebratory glass of cheap Chateau Rinse de Bouche over an FP17. [For those of our younger colleagues unfamiliar with such things, these were the old claim forms that allowed a course of treatment to be ‘claimed’]

Complaints were rare. The GDC were a body to whom one looked up in awe and respect, and yet who played little part in day to day practice. Indemnity was low cost as was the ARF. At some point in one’s career one would make the decision to up the standards of ones work and seek to change the way one practiced. It was a cycle of professional life.

Meetings [long before CPD became a fashion statement] were a cacophony of chit chat about practice matters.

Morale I would be so bold as to say was always, broadly, high

So what on earth has happened? How do we find ourselves at the edge of a perfect storm of change for the worse?

The GDC are a runaway train of high cost complaints handling and we are all paying through the nose and other orifices too, I should think. The persistent arrogance and lack of accountability of the GDC and its leadership remain a real cause for concern. A worry in part because they affect us but we do seem to be able to affect them, nor can the PSA, it seems.

Just look at Indemnity as an example. On the one hand it is a significant chunk of income on an annual basis, now being compulsory [so the lawyers can REALLY get their teeth into you]. On the other hand, despite reassurances, there is a pervasive sensation that they will dig you out of a shallow pit of excrement, but if you are truly up to your neck they may simply leave you to flounder. A worry in part because they affect us but we cannot affect them.

Now we have news of the falling away of dentist incomes. In a separate and apposite piece of Government news, even that respected statistical body HSCIC, thinks morale is a worry amongst dentists. Now incomes falling is hardly news because most of us have noticed this in the last 5 years. How? Well, we run these efficient Micro-Businesses, Minister and produce the annual accounts.

Practice Plan’s latest Confidence Monitor is hardly an advert for happy campers under the Governments clinical cosh that is the UDA. The vast majority of the NHS dependent sector must be feeling very uneasy.

What has caused this change of circumstance? Why are all the pointers suddenly running the wrong way? If morale is a precarious state of mind, all this news must surely cause the spiral of decline to turn more quickly unless something is done?

Can morale fall, like the rain, in stair-rods?

Now hold on Dr Prism … Dentists are a resilient bunch – we get by, we generally don’t moan, and we take the rough with the smooth because, let’s face it, there are many worse off than us and despite what the Daily Fail et al may say, we do have a social conscience.

In our day to day work, we [you me and all the other GDPs] take personal responsibility for our situation. It is up to us to be happy … or not as the case may be. It is up to us to run our businesses. All good so far.

But for the bigger external problems we rely upon an external body to do our work for us. We reply upon our Academic colleagues to lay out the ground for evidence based clinical practice. Not some random bunch of Red Braces in Wimpole Street who would not know a dental practice if it hit them on the head! We rely upon a representative body to keep the bad news at bay – to fight off the bad guys as it were.

Where are the BDA as our ‘Union’?

Perhaps they themselves experiencing a decline in morale as time and again they fail to make an impact against the onslaught of Government regulation and initiative? Not so long ago there was the change of subscription system and I seem to recall there was a ‘bit of a fuss’. Even on a professional matter such as obesity and the sugar debate, it was the medical fraternity that snatched the victory, and the BDA were left to issue a “told you so” PR statement which barely caused a public ripple.

Perhaps the lesson of influence here was that we need strategic alliances to amplify our voice and our influence.

Why is the BDA so effective on so many levels of “back office” matters and yet on the “Front Line” of headline influence and involvement, it is abjectly falling short. Why is it that as a body of 20000 dentists, they are neither first to be thought of in the media domain nor are they regarded with respect by our political masters?

Incomes … the UDA system … the Prototypes … the CQC … the GDC and its quisling Dental members … the GDC and it expansionist ambitions … FtP … more FtP … Professional Morale … a vision for UK dental care … Children’s Dental Health … Young dentists and early training... Planning for Tiers ... the list goes on where as members [and non-members] we cry out for some serious bloody Bolshiness – and time and again we feel they fall short. Too busy having ‘polite meetings’? You might say that, but I could not possibly comment.

By and large of course those who are in private practice are able to manage their lives and rise above the challenges of NHS practice. This indeed is reflected in the consistent theme of the HSCIC, Practice Plan and others: their findings relate to NHS practice

So if the NHS GDP is the poor bloody infantry, who are their Generals?

Well certainly not the new CDO, ironically Colonel [Retired], who is happy to discuss the present and future problems on the same stage as the very man who was their architect, now relishing his role as a non–exec director for a leading Corporate.

The sign of poor morale in an organisation can be its collective ineffectiveness of leadership.

Perhaps the problem of spiralling morale in GDPs is in part due to a perception of low morale at the BDA?

For sure as profession we need a dose of Feelgood Salts and a good kick where it hurts.

The season is underway.

The BDA need to start scoring some goals.

It’s not like the ball is not in the open, and for sure the net is wide open. The NHS GDP needs its leaders, its “Generals”, to start doing more than limply waving a PR flag. I suspect members would prefer one action over the hundred words of a glossy Press Release.

Can it really be a year since we and the BDA all went up in arms over the ARF change? A fine campaign of action but has 2015 seen it followed through?… It’s a sad reflection that, as no doubt predicted by Madame Gilvarry and Dr Moyes, the ARF is now seen as small beer – have you looked at your Indemnity bill?

Get a grip BDA.

Start earning your members fees. Before a large part of the profession withers under your watchful gaze.

Institutional Arrogance

Many of you will be reading this from the sneaky preview of your ‘mobile device’ while on holiday so I will keep my mumblings brief. Don’t want the present Partners or Spouses to my dear readers getting a holiday stress on!

Holidays are of course the time when you re bond with the family, and past troubles diminish in their significance such that when you return, the sun still shines and the daises are growing. Holidays allow a new focus on the real issues such as the performance of the many Premier League teams.

If you are single of course holidays can be a “fun” time, strangely challenging in some respects. The STO or Short Term One-nighter relationship can lead to some interesting morning conversations. Matters of Validity of Consent can raise their head.

And so it is, in your professional area of work.

I do, I do I do …

You will return from holiday to a focus on your note taking and records like never before. For some time this has been defensive, and a recent case [1] now confirms that it is not enough to record what treatment you undertook. You must now have a discussion with your patient about the risks or proposed treatment, and you must know your patient sufficiently well to apply context to those risks, and the end result will be that the patient should be able to agree to a course of action of their own free will.

GDC Standards for the Dental Team was of course ahead of the consent game by stating in 2013

3.1.2 You should document the discussions you have with patients in the process of gaining consent. Although a signature on a form is important in verifying that a patient has given consent, it is the discussions that take place with the patient that determine whether the consent is valid.

3.2.2 You must tailor the way you obtain consent to each patient’s needs. You should help them to make informed decisions about their care by giving them information in a format they can easily understand.

This of course all takes time. As busy GDPs in mixed practice, that is the one thing that most of you will lack. The threat of an FtP case against you however focusses your mind.

Welcome back to the Autumn of un-squareable circles, as the GDC in their lofty arrogance see no reason why you should have a problem, that body being out of touch with reality.

OK … Talking of that body the GDC …

If you have not heard, the problems have officially been fixed. Hurrah!

The Professional Standards Authority issued a report [2] being most unfair & critical of the GDC. The GDC Press release [3] in response was beautifully dismissive – a masterpiece in Institutional Arrogance. Taking arrogance to a new level. Real Premier League stuff

We have already instigated a significant programme of change within the GDC which will help us to support dental professionals to deliver high standards of care and maintain public confidence in the profession.

You would never guess that the PSA were critical in the extreme, the GDC being a long way below the standards of other regulators. Someone has to come bottom of the class but the GDC take that ‘achievement’ to a new level. You hear the PSA sighing in frustration.

Constantly we hear the mantra from the Executive Suite in Wimpole Street that a new Parliamentary Section 60 order is needed. And yet we read in Fitness to Practice rules [4] as follows:

Initial consideration by the registrar.

The registrar shall consider a complaint or other information in relation to a registered dentist or a registered dental care professional, including a dentist or dental care professional whose registration is suspended, and shall determine whether a complaint or information amounts to an allegation

So the reality of the GDC’s crisis is that it is entirely in the hands of the Registrar to create a system to sort out the wheat from be chaff in letters of allegation received. Instead of picking true FtP cases, the Registrar operates a set of rules in which it seems that any allegation is considered seriously. Good grief, the Caseworkers are in some cases a contracted company.

The GDC has descended to the role of a commercial Complaints Handling body.

Standards is being used as stick to beat the profession and not as a level of practice to which to aspire.

Fitness to Practice is not a Regulatory function in hands of Ms Gilvarry, it has become a commercial operation of immense cost, be that financial to the wider profession through the ARF, the financial cost to a dentist under investigation, or of course the emotional cost to dentists.

The way that Ms Gilvarry operates demonstrates that she has mastered the delivery of Institutional Arrogance. In the Chairman, Dr Moyes, she has a willing partner who has revoked his role of oversight.

Who will rid us of this rotten leadership? The summer may be over but the need remains.

Coalescence

It is time for the six registrant members of the GDC to seriously consider their positions. I assume even they were shocked at the GDC’s Press Release. The BDA and FGDP, perhaps with DPL, & DDU, and perhaps with Denplan, Practice Plan et al, have a massive role here through the BDJs editor’s concept of Coalescence[5]. Action is needed to grab the attention of both the Minister and the Council.

Unless of course they have all caught the Institutional Arrogance disease

Copyright

Radiant heat from our nearest star warming the cockles of our hearts is a rare treat in these temperate climes. Some things never change though, and the weather is one of those. I am sureby the time your read this, moaning about the heat will have rapidly become the usual philosophic whinge about the rain and wind! Maybe we should talk to our patients about the GDC instead …

And so, it seems, the GDC are to be placed in the same weather related category of criticism. Always something to moan about.

But there is an unavoidable truth:

The Executive simply do not get it.

The problem, they imply is us moaning dentists - we just do so always go on about them. Get a life and move on, you hear, mainly from an anonymous adviser in Wimpole Street somewhere.

Exactly where are we?

They are castigated by the Panel Chairman in the Singh case – and we are not talking a “could do better” comment as per my old school report. We are talking having a “Door Closed, Hat on” interview [Those of a miltary background will recognise that as being as bad as it can get] in which the conversation was very much one way. I think we can imagine the Chairman was using a raised voice when he dictated that little lot! This of course , suggests the GDC in its imaginative defence, was all down to a one-off with a rogue GDC lawyer who has ‘moved on’. Funny that.

Not satisfied with that there has been a Professional Standards Authority Report. To suggest it is hardly complimentary would be an understatement. Bottom of the Class. Absolutely useless. You decide! The tone of the recent GDC Newsletter for us all suggested they had passed with flying colours.

Do they really think we are that stupid?

Many members of the profession have written vociferous, well-argued letters of complaint to their MPs. Although duly acknowledged and in some cases passed on it seems to the Secretary of State for Health, Rt Hon Jeremy Hunt MP, little action or redress seems to be being planned. That said, the MPs and Ministers would be unlikely to signal the intention of Parliament.

The Damp Sqib of the Health Committee

It's not about you. It's about not rocking the boats of politics.

The Health Select Committee of the House of Commons Accountability Hearing has turned into a damp squib simply because an Election intervened. The HSC committee has only just had a Chair voted in, and the committee has yet to be elected, at the time of writing, in a secret ballot of MPs. Replies from Dr Wollaston MP suggest that the Health Committee might reserve a right to recall the GDC but it is hardly stirring stuff.

You wouldhave to be very naïve to image the GDC and its woes are likely to be sliding off the top of the Minister’s full in-tray. Political agendas are notoriously hard to influence.

But what weapons do we have to drive change at the GDC?

We could continue to write to our MPs and let the heat of correspondence volume light the fires of scrutiny.

We can continue to write to the PSA but they do not have the powers required.

We could as a profession, call an Emergency Conference – perhaps jointly led by the FGPD, the BDA and perhaps an Indemnifier. As well as a Vote of No Confidence, we could request the resignation, in the name of the wider profession, of the dental members of the GDC. There are only 6!!

Peep Peeeeep?

We could ask that the Council registrant members use their Whistle-Blowing policy. Now ironically, they have to go the Chief Executive, or The Chairman [I think not ...] or the PSA … who have just issued their terrible report, and whom, of course, … have no authority to do anything!The PIDA [The Public Interest Disclosure Act] list at the GDC Governance Document written for Council members statesThe specified matters should be issues that are in the public interest, for example, under the PIDA these are:

a criminal offence that has been committed, is being committed, or is likely to be committed; including actual or suspected fraud or misuse of funds;

failure, or likely failure, to comply with a legal obligation;

a miscarriage of justice has occurred or is likely to occur;

an act causing or likely to damage to the environment

actual damage or risk of damage to the health and safety of any individual;

deliberately concealing or attempting to conceal information relating to any of the above

Well it strikes me based on the cases reported on the GDPUK forum that the GDC are certainly open to accusation on at least three of that list - I will let you adjudge which!

GDC Standing Orders for the Council permit either an Emergency Motion [SO 3.7] [requires at least 4 Members to sponsor it] or a Routine Motion for discussion [ SO 4.3].

If anything such as a Council Vote of No Confidence were to occur it would need a pretty unanimous vote by the Council and would patently be resisted by the Chairman, Dr Moyes since these items are perversely at his discretion.

So where are we ?

You have to give the Chairman and his Chief Executive due credit – their hides must be sun baked to a hardness not previously seen.

For Accountability Hearing at Parliament, it looks more like an Accountability Holiday!

The Registrant members by their silence speak volumes and it would appear that they are happy to take the GDC Shilling.

The BDA are trying, as are the FGDP but are it would seem simply bouncing off the armour plated skins of the Executive.

That leaves us – you know, that’s you, me and the others - to make a public gesture of some sort.

A Conference it has to be Ladies and gentlemen to offer a vote of no confidence and to request the honour-bound resignation of dental members of the GDC

Who will rid us of this corrupt and disgraced body?

It has to be us, everyone else has sadly left town on the Accountability Holiday Omnibus

Copyright

That third letter has a lot to answer for. What DOES it stand for I wonder?

Competent?

Well, the GDC are adamant. In their role as a “Council” They are improving immensely, and have refuted the FGDP’s assertion [1] that they have not "learnt any lessons" after their 2014 ‘Annus Horribilus” [2]

Given that when you are bumping along the bottom, the only way is up, I guess we should on the one hand be grateful for small changes and perhaps acknowledge that internally , the GDC are attempting to re-configure the disaster that is FtP.

Speaking with the Dento-Legal teams, there is a sense that the peak, the height of the tide of FtP, if you will, has either passed is passing.

Complacent?

The GDC in their latest report state [3]

9. The triage KPI has improved and is being met in almost all instances. 99% of cases were triaged within 14 days in Q1. This has now been 97% or above for three quarters in a row.

10. The Hearings KPI was met in a smaller number of cases in this period. 61% of cases were heard in Q1 within 9 months of referral from IC. This has reduced from 67% in the previous quarter. However, a much larger number of hearings were held in Q1 than Q4 (66 v 37).

Add to that the pilot schemes to require that the NHS get its own house in order with matters of performance and one can see that the steam pressure in Wimpole Street is indeed reducing.

Perhaps it is wrong to regard the GDC as a Great Day for Complacency? Internally, it appears we have an organisation finally “getting it!”

On an annual basis, it appears that FtP cases may reduce by some 300 to 350.

756 cases were received in Q1, when as many as 825 may have been expected.

So we can expect at the very least a static ARF in December … can’t we? Too much to hope that the GDC’s success might result in an ARF reduction!!

Talking of which, I wonder what the HoC Health Select Committee report will state. It all seems so long ago now. In fact, I can even see the GDC Press release batting it away like an annoying fly in an arrogant, even corrupt sort of way. The FGDP pulled no punches for sure. [4]

Corrupt?

We could discuss whether the GDC are a corrupt body [5] – not in the fiscal sense, but in the aggressive occupation of the moral high ground. The FGDP have a point really – the GDC have utterly lost the confidence of the profession. It is a measure of their arrogance that they fail to see this. It is a measure of their insularity that they see dentists as a minority Registrant group.

I wonder what it will take for all those dentists and DCPs who partake in the FtP Process and indeed sit on the Council to withdraw their support.

Well, they might wish to consider their position on the matter of the GDC being in discussions with the Dept of Health to see how to amend the regulations to allow the new Oral Health Assessment to be undertaken by Therapists.

The well-worn phrase of Lord Acton suggests that while all power corrupts, absolute power corrupts absolutely.

I put it to you that the GDC is indeed corrupt, by throwing away its independence in its dealings with Government.

It is not acting in the best interest of the patient, it is acting in the best interest of the Minister of the day.

Correct, Competent, Campaigning

The FGDP and BDA are suddenly standing up; their heads are above the political parapets and dentists, as a profession are starting to demand to be heard, to be counted. Join one, join both, but do sit idly by.

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Is it safe to come out from my cave now? Can we talk politics? It is tempting to be cynical and use that worn phrase, Plus ça change … [1]

To those of you with connections in Nepal, my sympathy and best wishes - coping with such a series of natural disasters is never easy. The Nepalese Governments rejection of the UK's Heavy Lift helicopter offer suggest that politics can rear its ugly head in any circumstance.

In a small way, I suspect UK dentistry will prove no different.

Unfinished Business

The election has been and gone. [You have noticed, haven’t you?] As revolutions go it was typical – the outcome was unexpected, although change was assured. Everything is up in the air, and yet already the dust is settling and the view of the future challenges is clearing. There is a sense of unfinished business in many respects, allied to concern that reform, be it to Regulatory Bodies or or Contract Reform, is going to suffer Mission Creep

In the space of a month for all its abject lack of mention during the election campaign, there has been a series of small seismic shifts in dentistry.

Tremors of Change

The new CDO was appointed [2] and Colonel Dr Sarah Hurley's name was confirmed; although announced on the NHS England web site, it is strangely absent from the DH Portal. NHS England stated:

Sara will ….. champion the role of dentists and dentistry within the health system.

I look forward to that because it was for sure absent under the previous incumbent who even now is espousing the increased use of Dental Therapists. Her military experience should stand her well in trying to wrench the proud profession of dentistry away from the red braced bean counters.

The BDA Conference, following on the heels of the UK wide Vote, was a successful venture, multiple stages and speakers offering a cracking breadth of topics to hear about. Big Dr Mick issued his rallying call, [3] and if anyone can lift an Agincourt like salute to the DH, he and his PEC are your ‘archers’.

The election threw an unpredicted outcome of a moderately strong Government, albeit with a large degree of SNP oversight.

The former CDO has already hit the lecture circuit and interview network, the glossy big magazine from Practice Plan being the one to catch the early eye, but with what agenda in mind it remains to be seen, except perhaps to self-aggrandise the achievement of the 2006 UDA contract. A strange retirement project I would suggest.

Jimmy Steele, the ubiquitous Toon Professor of all that is good, has spoken about the new Prototypes in guarded terms [4] – suggesting that we are heading toward a sensible format for NHS funded dental delivery. The nature of his caution suggest that money will be the driver or the deal breaker. Model Two appears to win his tentative vote at this time

Perhaps most interestingly, the FGDP, in a move to assist beleaguered dentists, has made their standards Open Source, [5] as well as criticising the GDC and its appointed ‘experts’ for constantly placing the bar too high in FtP cases. The GDC it must be said have publicly challenged this respected professional body. [6]

So what now?

We now face the prospect of proper austerity, with a new budget in July. Further real cuts are forecast and I for one would not bet on dental funding under the NHS increasing to ensure proper delivery of any new contract. Suddenly massive promises are on the horizon for 24/7 operation allied to an increase of 5000 WTE GMPs – and you can see dentistry as funded by the Government being parked up a narrowing alley.

So the rallying call is very simple –

We must expose the lack of clarity of the NHS offering which looks to be similarly present under the new contract proposals.

We must drive increase dental funding to be directed at child dental health

If ever the case for fluoridation should now be put to bed, it surely must be now – the cost effectiveness alone must appeal to a newly empowered Chancellor.

And the GDC are still awaiting the HSC Report, but our regulator is hardly a reformed body despite their strongly worded rebuff to the FGDP

Dental revolutions are often subtle, like slow burning fuses. I think there are a number of fuses smouldering here. The summer should be interesting because at some stage there will be a loud bang.

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These are politically exciting times in which we live. The earth shaking events in Nepal are unrelated of course and to those of you connected in any way, I hope that our thoughts and prayers provide comfort.

The French have had their revolutions. So have the Russians. The North American history is littered with conflict. Closer to home the Scots were victim of some brutal clearances. The Irish found themselves on a similar receiving end of some English-driven realpolitik. The English have had their civil wars be they flower based or parliamentary in origin.

The definition of the word revolution includes this:

a dramatic and wide-reaching change in conditions, attitudes, or operation.

And now we are about to witness a UK wide political revolution. A conflict of ideas and ideals as dramatic as any more military revolution.

On Friday the 8th May, the manifestos of the various parties will be torn into small bargaining chips. All political discussion will become secret and behind many sets of closed doors as the hidden powerhouses of advisers thrash out a deal which allows either Mr Miliband or Mr Cameron to pay a visit to Her Majesty and request that they be allowed to form a Government.

Your conversation with your patients on Friday 8th will at least be a bit different from the usual weather and holidays. But what will you think? If we have no clear large party, by definition we have a coalition at best and minority Government at worst. First past the post only work if you have a winner. Imagine you are overseeing a race and because you forgot your stopwatch and glasses, the result looks like a sort of fuzzy dead heat where does that leave the voting system? In dentistry of course we used to have transferrable votes for electing the GDC - heady days, eh? We were ahead of the game I suggest.

Where does this leave dentistry in the minds of our politicians?

I for one find it quite extraordinary that less than a year ago we as a profession were making headlines with child dental health and child hospital admissions being the headline concern, but allied to issues of obesity, diet and refined carbohydrate. You all know what it takes to be dentally healthy.

The drive for caries-free children is not a mystery. You all know that.

Dentistry... why, is there a problem?

So has dentistry been, if not a headline element, perhaps a second string part of any debate?

Nah. Non. Nyet. Not a dicky bird. It’s as though the 45% of the population who never visit a dentist are happy to take their own teeth out, [and for those of you so inclined to listen again, our colleague Dr Tony Kilcoyne had to endure a strange slot on Jezza Vine on BBC R2 recently].[1]

Meanwhile the 55% of the population who do visit a dentist are commendably happy with their service and experience, and are no doubt filling out the FFT as we speak.

Well they will be, until told by dentist A that their crown and root canal must be privately funded, and yet dentist B can provide the same treatment for a friend under the NHS and everyone is correct!

Clarity of NHS provision in dentistry is a ticking political time bomb with a shortening fuse. The lawyers are the ones who keep relighting the fuse and at some point it will be a major problem.

And yet sadly, dentistry has as a profession and an NHS Primary Care service been parked in the sidings of political irrelevance. We have in political terms, been marked with a large tick.

Have the politicians taken their eyes off the dental ball? You might think so. If you read the NHS Confidence Survey by Practice Plan, [2] the mood of dentists is darkening from so many angles it is hard to find true optimism anywhere for Government funded activity. [3]

Well come the 8th May we are going to witness the start of a Revolution whoever polls the most votes. Indeed those who poll the least may feature the most.

Perhaps dentistry will feature during the post-election negotiations?

And of course for those of you in Manchester for the BDA Conference… [4] Well maybe that will be the long-needed start of a dental revolution.

It’s not too late to check in and go have an excellent three days of networking and updating across a huge range of dentistry

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As of writing, there are about 30 odd days to go to the UK General Election [1] and politics may have changed for ever. The 2-party system may well be broken. It seems likely that the smaller parties will have a relatively huge amount of influence over the eventual policies of the Government that emerges. If Proportional Representation had no role to play in “First Past The Post”, it perhaps does under a mixed multi-party system of coalition where FPTP does not produce a clear Government. A clear outcome is … well, far from clear. I sense a theme I might return to.

Who remembers the HSC?

Until then of course, we are in the frenetic work up to Election Day across the UK, allied to significant numbers of local elections are due to take place on 7th May.[2] Parliament dissolved of course at the end of March. The Health Select Committee report of the GDC Accountability Hearing will now have to be signed off under the new Government. Wouldn’t you just love to know what’s in the draft that no doubt sits in a pending tray somewhere? You can never get a decent leak when you want one! For those of you with short memories in Wimpole Street, it was clear the HSC were collectively unimpressed with the performance of certain executives.

Dentist in Politics

Many Dentists and Dental Professionals play their part in local communities and will have local or national agendas of their own. To all of you, the very best of luck. It’s a busy time. Stay focussed and may the votes go your way.

Indeed in the GDPUK forum we have our very own blogger Dr Pramod Subbaraman [3] who is a parliamentary candidate for the Liberal Democrat party in Edinburgh South. Scotland of course are still vibrant in their political engagement after the 2014 independence referendum. Sir, we wish you well. Ironically, if present polls are to be believed, the Independence agenda re-emerge after the election because of the influence of an enlarged Scottish National Party in the House of Commons.

More wet fingered dentists in top level politics is a positive process – it can only help the cause of the nation’s Oral health and ensure that the dental and oral health inequalities rise up the political agenda. There is a sense of “Rome burning” about the facts on the ground of GA Admissions for children for surgical dentistry [4] while the Department of Health and its mouthpieces at NHS England assure one and all that the system of UDA related access has clearly been a big success, broadly speaking. I really must get a new pair of hindsight-o-scopes.

You ARE political influence

But imagine you are standing around one day in your local market place and the candidates for your local seat are canvassing your support. You were planning to “do you bit for the profession” and therefore plan to ask one question.

What should it be?

What would swing it for you if a candidate were to ask you for their vote?

Let me take you back to a previous blog in which I raised a “Trumpet Call for Clarity of the Deal”.[5] In it I suggested the GDC might take this role on and demand clear rules on what dental care is available under the NHS. For those who are interested, I did write to the Chairman of the GDC and he delegated his reply that “It was not their job”. Too busy counting the FtP hearings, I suspect!

The consumer organisation Which? [6] and the Office of Fair Trading [7] tear their hair out over the constant complaint that patients never know what’s available under the NHS and what’s not . Report after report is critical – and yet – this strange fudge is NOT of the dentists’ making.

We did not choose this system or the lack of clarity.

The DH chose this. It is the Department of Health who seem content to see dentists accused of misleading patients. What could their motive possibly be? Surely not to deflect eyes and attention away from the other concerns over Government funding and management of oral health?

It is patently wrong that every individual dentist should decide what constitutes ‘need’ on a one by one process with every single patient. How can anyone with half a political brain even remotely justify it?

Unclear Prototypes & Mixed Practice

The new Prototype Contracts are being rolled out at “Pilot” level and still there is no clarity. The now retired CDO was on record as saying it was not required as part of the new contracts. We can but hope that the new incumbent will see sense and change this unsustainable approach.

The future of dental practice in this country will depend on the success of mixed practice.

The ability to fund privately some dental care alongside an NHS funded element is critical to the small business that is dentistry. Multiple strings of income may well be the ONLY reason that many practices will continue to subsidise the State offering for the benefit of their patients.

But there have to be clear rules. At the moment there are NO rules. In fact it is so ridiculous at the moment that the rules appear to be written only when the patient complains. At that point the GDC seem to think that investing in your London Day Care might be a jolly good use of funds.

If McEnroe had been a dentist ...

Our old ranting tennis star John McEnroe would have had something to say. “You cannot be serious” [8]

The patient has a right to know where the boundaries lie. All patients should be able to share an experience of the same rules being applied. The dentists need to know where the boundaries lie.

Otherwise there is a great risk that the GDC call you to order at an FtP hearing should the patient complain that you applied too harsh a judgement of NHS “need”.

So the one question, I put to you, that you should raise with your candidate who asks for your vote is

“Will you ensure Clarity of NHS Dental Treatment?”

Our politicians need to look at dentistry through the patients eye’s, not through the upturned bottle lens that the Department of Health use.

Patients deserve better and it is the Parliamentary candidates you will meet in the next 4 weeks who will influence future policy

At present 22000 dentists apply different rules across 20 patients per day – because that is what the DH require.

That’s half a million confused patients per day

Ask them: Will you put a stop to the confusion? Will you provide absolute clarity on what the patient can expect under NHS dental care?

If not, why not?

Meanwhile – control that excitement out there. I am off to watch some paint dry …

“Now, will you be voting Mrs Goggins, open wide, there’s lovely, bring the next one up Nurse …!

Makes a change from talking about the weather and holiday plans. May your Easter break be relaxing and Spring like. The onslaught has yet to come!!

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Last week saw the GDC Accountability Hearing - the link is below. If the state of play of the GDC is anything like England's cricket, thety are back in the pavilion and on a losing wicket again.

As presentations go, it reeked of nervousness bordering on the incompetent. Professional beaurocrats being good at their jobs – which in this case seemed to be to avoid answering questions and to avoid taking responsibility.

I know it is the ultimate in boring TV that may well not come a close second to Jeremy Kyle – but do it, people. I strongly suggest you watch it. In fact why not mail me privately and I will send you a vCPD Certificate for 2 hours.

Answer the question, if you please Dr Moyes

It started dramatically as Dr Moyes seemed ill prepared to answer the first question directly much to the annoyance of HSC Chair Dr Sarah Woolaston. Dr Woolaston is of course medically trained. Dr Moyes’s doctorate in Theoretical Chemistry may have been of more use if he had majored in The Chemistry of Body Language, whether from in front from the MPs or indeed from behind, where a motley commoners jury of his dental peers had gathered.

Given that on appointment he was nice kindly “Bill” I do wonder if he has started using his proper title to gain some presence in the company of those he seeks to lead?

The state of play with FtP

If there was one line of questioning that caught my eye, it was Rosie Cooper MP “What is the current state of play with respect to FtP?” she asked time and again.

She drilled deep on the state of FtP numbers. Persistent as she was Ms Gilvarry simply did not know the answer. It was stark, and if it had been a job interview, she lost the job at that point.

So I urge you to watch this report.

By watching this select Committee meeting you will learn:

· Why parliament is to blame for failing to legislate

· Why the Professional Standards Authority audit is flawed

· Why confidence in the GDC profession wide is actually high

· Why the GDC see Dentists as a minority stakeholder group

· Why the BDA is a minority representative body of a minority stakeholder and can therefore be disregarded

· Why e mails from the GDC are not arrogant

· Why a case load of 1400 per year was reported as doubling

· How this was used to justify the ARF increase

In turn how 1400 doubled means an annual case load of 1600

· The nature of body language in communication.

· Reflect upon the quite informative posturing by both the Chief Executive and Chairman toward each other.

· Learn About the GDC having a contract with the NHS’s National Clinical Assessment Service for triaging FtP with clinical input.

· Why dental knowledge and experience at Executive level is not required

· The Patient panel of 5000 patients, 2500 of whom are mystery shoppers coming to a reception desk near you soon

· How to avoid answering a question

· Which lessons have not been learned and will, in the opinion of the Select Committee, will never be learned.

· How, as a Chairman, your role is to protect the Council at the expense of your Chief Executive

Copyright

Those of you of a certain age may recognise my poor attempt at an ironic pun. That of course is nothing to do with my age – I am just a poor punner, so to speak.

One Week to go, Eight Weeks from certainty,

We are 8 weeks from a General Election the outcome of which is regarded widely as the most uncertain for many generations. We are also less than a week from a most important event: Roll up, roll up, it’s the GDC under the microscope of political accountability … [well, hopefully!]

By the time you read this the House of Commons Health Committee will have parked dentistry [though the GDC Accountability Hearing] on the electoral back burner. We’re done, the politicians will say, slamming shut their leather bound folders.

Long live the GDC

Of course we have all blown a lot of hot air about the GDC. I for one wrote majestically of the

“Delusional Management Executive and Council, demonstrably out of touch with the real events”. I have to say I was rather proud of that!

What’s the point is making such a comment, though, if the examining Health Committee were to be so easily misled by a slippery GDC presentation? We shall see. Our medical colleague, Dr Sarah Woolaston [a GMC Registrant] strikes me as a good pair of hands to chair the Committee and we live in hope that the GDC are “flamed”. I for one called for the GDC to be placed in Special Measures. Will there be tears for the GDC? I suspect not.

So for this Parliament, dentistry is all over. The Chief Dental Officer [NHS England] appointment is not even worthy of news yet.

Tiers of Tears?

And yet an ominous clinical change is afoot which will potentially be a most divisive one. I refer to the introduction of Tiers to the delivery of dental care. Orthodontics is now beginning to see it being proposed, while it has been flagged for some time in GDP and of course Oral Surgery have systems being rolled out.

In essence, perhaps we could liken it to our childhood friend Noddy:

Tier 1 - Noddy can talk to Big Ears about driving but not drive a car

Tier 2 - Noddy can drive, but not on the road at the same time as Big Ears

Tier 3 - Noddy can drive on the same road as Big Ears at the same time

If there is one subject you should examine for your future practice, I urge you keep your eye on this ball. As a young practitioner, it may simply guide your career development.

But as an older practitioner, the way these tiers are being mooted may expect to have an enormous impact on your ability to provide more advanced dentistry as part of your mixed practice.

You may wish to plan your practice development now, before the prototypes come in and before Tiers are presented to you on a plate, rather like a new diet of limited crumbs

Because I suspect many practices are only truly viable because of the ability to mix NHS and private care. Their clinical skill comes from the apprenticeship that is a life in General Dental Practice

While Tiers are arguably driven by good thinking about the big picture, and are here to stay, I worry that the unexpected outcome will be to drive unexpected massive change through older practitioners, who in many cases of course are the practice owners. In all of this, the reality of Austerity 2 after the election – there has already been flagged real terms budget cut of up to 20% - makes the reality at GDP level quite different

Don’t let you and your practice be the one to experience Tears for Fears. The Law of Unexpected Outcomes may well be alive and well

Valedictum

On a closing note, not unrelated, I am sure tears will be shed for the retirement of our colleague , the Chief Dental Officer, Dr Barry Cockcroft. The old position of CDO was of course downgraded, politically speaking, to NHS England, now outside the Elephantine corridors of power in London. This poacher turned gamekeeper [for he was indeed in high office at the BDA] can have improved access to a safe retirement in the knowledge that his project of UDAs has lasted the test of time, even if did not pass any other test!! Let us hope that the next incumbent of the position does not also leave office with the same defunct system in place in years to come.

We reserve the right to have a barney with you Barry, but the least you deserve is a drink on us. A glass of Chateau Fluoride perhaps – the one with the varnished cork?

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I bid you all a good day. Those of you that have read “the books” will have no doubt pondered the extracurricular uses of a dental dam and floss for example. This weekend of course see the film emerge – regarded by many as a rather poor representation of the book, in itself not exactly a literary classic, I am told by others you understand …

You see, its a little known fact: GREY stands for GDC Regulatory Examination for You

This week sees the 2015 Accountability Hearing with the General Dental Council by the Health Committee of the House of Commons. [1]

You have 4 days to respond

This is very much the Headmaster’s Interview.

Now do not get over excited - this is not going to be passionate demonstration of Parliamentary S&M as the Chief Executive of the GDC is tied up and verbally thrashed by rabid members of the committee.

You only have to explore, for example a past accountability hearing of the GMC or the 2014 Accountability hearing with the Health and Care Professions Council to realise much of it will be affirmation of what has been undertaken on behalf of Parliament. An Annual Report to Stakeholders. There is a danger that the men and women in grey will merely spend the day formally noting this and noting that. The stench of white emulsion may well fight the colour sense of a very dull affair. Potentially grey indeed.

UNLESS YOU ACT …

We dentists and our teams must use this opportunity to raise the GDC up the Parliamentary agenda. At the end of this hearing it should be clear that the Health Committee are examining a failed organisation with a runaway budget, and absolutely no idea about how to organise FtP. The Committee should be under no illusion that the profession regulated by the GDC is running scared and disengaged in the extreme, while the report from the Professional Standards Authority could have used one word to describe the GDC: Useless.

Proper calling to account of the GDC simply will not happen if we allow The GDC’s presentation team to smooch their way under the skin of the Committee unchallenged in any way.

UNLESS YOU ACT …

We, as registrants, must assume that the BDA, Dental Fusion, and other professional representative bodies are submitting some solid evidence. If you are a member of Dental Protection or the DDU and MDDUS you may assume these widely respected bodies, which are in the thick of FtP, will be presenting heavy hitting material of their own. If you want to be sure, ask your Indemnifier! One would like to think that the FGDP[UK] also will rise to the challenge.

There really is only one major area of concern that the profession has about the GDC – it is the abject mismanagement of Fitness to Practice and its cost implications allied to the inevitable. but unwanted, change to excessively defensive practice.

No one is suggesting there is not a task to be undertaken. But the sheer crassness of assuming every banal criticism reflects a wider risk to the public which must be aired expensively and in public beggars belief. If like me you read the Charges are of the GDC website, [2] I am sure you cannot fail to agree that many of the cases simply are not worthy of a full FtP process at £78000 of YOUR money PER DAY …

UNLESS YOU ACT …

If you have an experience of FtP I must ask that on behalf of your colleagues you summon up the strength to report your experience to the Health Committee as I am sure Mr Colin Campbell may well do. Please do read and share his blog [3] As if by serendipity, as this Health Committee is meeting a colleague, Mr Colin Campbell, is beginning to publicly reflect upon his most extraordinary experience at a full GDC hearing. The sheer injustice is almost mediaeval in magnitude. And to think that many of our colleagues sit upon the panels. Whether they are part of the problem of course is a separate debate.

If one event appears to demonstrate all that is wrong with the GDC and its massive problems this case might be it.

If you live in fear of that letter from Wimpole Street and feel FtP is an issue, write to the Health Committee.

UNLESS YOU ACT …

Keep it brief. Keep it factual. Keep it succinct and to the point. But please: communicate . The Committee’s guidance on a submission may be read here. [4]

This Accountability Hearing does present our best opportunity since the ARF Court Case [which despite the GDC claims, I seem to think they lost!] to flag to the Health Committee the many concerns we have as registrants. I suspect we might have to remind the HC of this Court Case if we judge by the GDC Chairman’s e-mail and his failure to mention it!

Do not count upon the GDC to present anything but a self-congratulatory review imbued with a warm rosy light .

If the Health Committee are to gain a true measure of the profession wide disbelief and anger, you have a small but essential part to play.

Remember that cheque you wrote before Christmas … the £900 odd pounds one ….

It’s payback time

50 Shades of Grey …. More like a Multi Coloured Swap Shop of stories of disgraceful Regulation in action. Now I am showing my age ! [5]

The deadline for submitting written evidence is 5.00pm on Thursday 19 February 2015

152.—(1) Select committees shall be appointed to examine the expenditure, administration and policy of the principal government departments as set out in paragraph (2) of this order and associated public bodies.

· To successfully make a submission via the online form on a committee’s website, documents need to:

o Be less than 25 MB in size

o Be in Word (doc, docx, rtf, txt ooxml or odt format, not PDF)

o Contain as few logos or embedded pictures as possible

o Contain no macros

o Comprise a single document. If there are any annexes or appendices, these should be included in the same document.

o It also assists the committee if those submitting evidence adhere to the following guidelines. Each submission should:

o State clearly who the submission is from, i.e. whether from yourself in a personal capacity or sent on behalf of an organisation, for example the submission could be headed ‘Written evidence submitted by xxxxxx’

o Be concise – we recommend no more than 3,000 words in length

o Begin with an executive summary in bullet point form of the main points made in the submission

o Include a brief introduction about yourself/your organisation and your reason for submitting evidence

o Have numbered paragraphs

o Include any factual information you have to offer from which the committee might be able to draw conclusions, or which could be put to other witnesses for their reactions

o Include any recommendations for action by the Government or others which you would like the committee to consider.

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What ever happened to January being a dead month when we hunker down to pay all our Christmas credit card bills? The CQC close a Salisbury practice facility [albeit for a month only]. [1] The GDC’s CEO has written a feisty fob off letter to the BDA [2], revelling in the end of year report she produced .[3]

But the real January action comes from two directions.

What? Which? Again?

The Consumer organisation, Which? Have published a report on the lack of clarity of dental fees. The link [4] below will allow you to read this. Indeed follow the page and you will find many leading colleagues at Oasis and BUPA all shouting loudly in favour of clarity of fees [5]. Indeed across the profession, and for sure on GDPUK, there is agreement that charging a fair fee is not the problem, it’s about letting the patient know in advance and giving the patient a proper chance to consider the fee and their decision.

“Clean Up Dental Costs” is the clarion cry from Which?. They already have quite active assistance with understanding dental costs at [6] and [7].

A Mixed Game

Of course the problem seems in part to lie in that murky area of practice, where some treatment is NHS funded and some is not. Mixed practice, in which the sliding scale of gaming can be applied.

“If the patient pushes, I can do it under the Nash, but if they don’t object I will whack in a proper fee because they don’t REALLY need it …”

Which? state in their campaign “Mission Statement that

We're calling on NHS England and regulators to make sure all dentists comply with existing rules and make information on prices clearly available. Dentists need to explain the treatment options properly and make sure patients know whether or not their treatment is available on the NHS.

Here is my challenge:

How can dentists be expected to explain how much or what treatment is available under the NHS consistently across the country when NHS Choices states that “all treatment that is deemed necessary“ is wholly available and yet it is the soon to be ex-Chief Dental Officer himself who has repeated that this decision of need is down to the individual dentist, in front of his or her patient.

Patently this cannot go on. Perversely, the Chairman of the GDC, being an OFT man ‘n’all that might be just the ally the profession needs.

As if by magic, albeit with ironic timing, the Department of Health’s long awaited Prototype Contract Document has emerged [8]

Nothing changes – the dentist decides “need”

Crucially, the suggestion is that nothing changes so far as the clarity that Which? and many others want.

The DH State

26. It is particularly important to be clear that nothing in the changes planned is intended to reduce or change the scope of NHS care available to patients. The changes are intended to ensure clinicians are supported to deliver the full range of care appropriate to a patient’s need. As with medical care, the NHS role is to meet clinical needs.

27. There is also no intention to end a patient’s ability to choose, if they wish, to have private treatment alongside their NHS care. As now patients will continue to be able to choose to have NHS care, private care or a mix of the two.

So contrary to what the Which? want, the DH propose to roll out yet another way of delivering dental care in which the opportunity for mixed practice will remain, but the rules are decided by the treating dentist with his individual patient.

So, not one consistent rule for all to work to but 22,000 odd individual rules and utter confusion for the patient. And more fodder for angry consumer organisations and patients “who know their rights”,

Is this really the best the DH can come up with?

The GDC are clear in their expectation – and this is COMPULSORY FOR ALL through their Standards for the Dental Team, [9],

PLEASE LOOK AT THAT WORD “PREFER”

1.7.4 If you work in a mixed practice, you must not pressurise patients into having private treatment if it is available to them under the NHS (or equivalent health service) and they would prefer to have it under the NHS (or equivalent health service).

2.3.7 Whenever you provide a treatment plan you must include: • the proposed treatment; • a realistic indication of the cost; • whether the treatment is being provided under the NHS (or equivalent health service) or privately (if mixed, the treatment plan should clearly indicate which elements are being provided under which arrangement).

Clear as Mud?

So the leading UK Consumer organisation are calling for the boundaries and costs of NHS and private dental care to be clear. Dentists and their LDC representatives are calling for the same thing. The GDC has made it compulsory for there to be clarity, and breach of this clarity demand will result in you visiting London for an FtP day out.

But the DH produce a Prototype Contract that suggest maintaining the present confusion.

Aside from it all beggaring belief, it is also now time for our Regulator to earn their spurs and take on the DH.

Calling Mr Moyes, calling Mr Moyes

It is time for the GDC to lay down to the DH in one hopes clear terms that lack of clarity for dentists and patients as to what is on offer under the NHS simply is not acceptable. It is no use asking the GDPC to achieve this for the DH simply bounce them.

This needs a man of words, in a position of influence, perhaps ideally with Consumer based experience, to deliver a Clarion Call for Clarity on what the NHS expect dentists to do, not for the dentists, but for the patients, whose very protection the GDC under your Chairmanship is charged with.

For those who despair at the actions of our fellow human beings at time, this weekend has been one to affirm that feeling. The 7th January will in time become as meaningful as 9/11 and 7/7 in its own way. [1]

What level of hatred inspires [if that is the right word] someone to kill a fellow human in cold blood? I for one struggle. In the ‘Je suis Charlie’ motif, a worldwide empathy has poured upon our French neighbours as they ponder a surreal weekend.

Dentistry does feel strangely safe after that sort of event.

Of course, while a small number of unexpected and sudden deaths in the street of Paris seems to trigger a media frenzy, the mass loss of death in Africa from Ebola, [2] and the even greater human distress in the civil war in Syria seem to lie uneasily on our minds. [3]

Perhaps we struggle to understand the magnitude of the Syrian problem – maybe that is one reason for the distancing of the issue. The UNHCR data indicates in excess of 3.2 MILLION people have been displaced. If you live in Manchester or Leeds, imagine just moving out. That is without pondering the 191,000 estimated deaths. [4]

West Africa seems so far away. At the time of writing over 8200 deaths have occurred from the disease

And yet 20 die in Paris and we are not moved to fill the streets. I wonder why?

As we all go to work this week, perhaps thoughtful, perhaps a little sad at matters outside our control, just take a little more time perhaps to help your fellow human suffering.

It’s what we do, and indeed it is by and large all we can do.

The 2nd January marked the date of the second Dental Profession’s letter protesting our Governments dishonesty in dealing with our small but proud and effective profession. [5]

Allthough the clock is ticking, The 7th May is after all far enough away that a week of reflection will do no harm.

It been a funny old year. As you sup your Christmas tot, you might perhaps take some time to reflect? Pull a chair up, let’s while away a minute. It’s cold outside, so would you be kind and throw a log on the fire?

For a profession that should really be quietly under the public radar, and in the state of a ship sailing steadily and smoothly, the waters have been mighty choppy this year. The raging CQC currents have by and large subsided, while the torpedo of the ARF, allied to the air strike that is Medico Legal costs arising from the FtP debacle, was a direct hit.

Tears or Tiers?

The winds of NHS “Tiering” are gathering, and forecast is that a storm will develop around the Prototype Contracts which has yet to peak. The UDA unfairness continues to block out the sun, especially for those of you who by whatever means have run out of UDAs for the last 3 months.

Great Deeds for Christmas?

The GDC have, shall we say, come to our attention this last year in an unprecedented way. The present leadership of the GDC have shown themselves to be arrogant, intransigent, out of touch, and in an irony befitting of their Standards document, utterly without a care in the world about the profession.

I hope you have not been in a time warp and that the events of the last few weeks have not passed you by.

The GDC now finds itself on the wrong end of a judgement at the High Court. Do not believe everything you read in their oh-so-friendly e-mails – honesty and transparency are two things woefully lacking in this broken organisation. However, they offer a level of Spin for which a former Prime Minister would be proud.

The time has come, the walrus said…

In answer to your question “What next?” I suggest you ALL whizz over to the petition at the link below to sign your support for the resignation of Mr Moyes and Ms Gilvarry. It is you, my friends who will keep this agenda alive – please do your bit. Responsibility must be acknowledged and frankly after this last few months, there can be no other honourable way.

There are 36000 Dentists and if you do nothing else to support your profession this year, please sign it. Unless of course you think the GDC are spot on and a fine example of public body efficiency…

But the BDA in contrast have risen to the challenge. If you are not a member, and can stretch to the additional cost, my commendation is at least throw them one year’s membership as a thank you for their action on your behalf.

Because of their resistance to the GDC steamroller, a process has been started at the political level which, in my opinion, will likely see some change driven by ministers over the next year. If you did not see the debate raised by our colleague Sir Paul Beresford, it is worth an hour of vCPD to see Mr Dan Poulter the Minister state unequivocally that in his eyes the GDC were bang out of order! This is the linkhttp://www.parliamentlive.tv/Main/Player.aspx?meetingId=16685&st=11:00:00

A Christmas Truce?

As The Christmas season passes [and for those not so inclined, may it be an appropriately Festive one] it is time to stop worrying about matters dental and just chill out with your family & friends. If you are like me and prefer your own company, may the mountain that you climb offer perspective and energy.

Perhaps we might find it in our hearts to wish all those at the GDC peace and goodwill.

So will 2015 quieten down?

We shall see. The agenda will change but it seems like there is much more to grab your attention on the way. To our young graduate colleagues, welcome to the funny farm and good luck coping with the massive changes that are brewing.

Be positive for 2015

Remember, the NHS is not the only outfit in town. Behind all the huff and puff of politics and the GDC qwankers1, private practice is a driving example of modern, efficient small business, focussed absolutely on patient care through a strong relationship with the dental team, offering a route to lifelong dental health aided by some amazing CAD CAM technology. Indeed the Good Ship SS Private Practice has been quietly sailing around all the politics and as any members of it ‘crew’ will tell you, when you sit down with your patient and start building trust, the rest of the world melts away.

If you have half an inkling to start a process of being less, or indeed NOT dependent on the Government for your business income, why not use the next couple of weeks to plan your first step. With all the changes afoot, allied to a certainty that there will be no more money when they demand extra activity from you, it’s the least you can do for your patients.

Life without the NHS actually makes tolerating the GDC a whole lot easier! And without NCAS and spurious GDC referrals, you will be a lot less likely to have your FtP day . Hurrah!!

So 2014 is a wrap.

To all my reader my thanks. To all of you, a peaceful end to the year and remember … they’re only teeth ! But they don’t ‘alf cause trouble, eh?

Copyright

T’is the season to be jolly
Fa-la-la-la-la, La-la-la-lah
GDC have got your lolly
Fa-la-la-la-la, La-la-la-lah

Enter Widow Cockcroft, the ghost of Dentistry past

Ah, ladies and gentlemen, boys and girls, will you just look at that Christmas tree – and who’s that on the top I see? Is that little Angel Evlynne? My that spiky tree looks painful… and she’s no angel, children believe me.

What a pantomime this is. Welcome to our very special Dental Land of Panto [DLP … grown up joke …. Never mind ]

Dr Mick – are you out there – yes children, look – there he is going into that nice big Law Court. Wave him goodbye will, you. Wish him luck Good Luck Dr Mick. A big cheer now … HURAAAAAAH!

He’s going to fight that nasty Baron Moyes and his henchperson the Wicked Witch

Do you know the story of the bad Baron? He was such a weak Baron that he failed to see how he was hurting the people who lived in Dental Panto Land. He taxed them and taxed them to the point where all they could do was… well, in the end children, they did pay their taxes otherwise they would lose their jobs and starve. It was very unfair especially on the young members of the Dental Panto Community. It was unfair on the old as well, and any one with children – actually, it was unfair on everyone!

It was all the fault of the Wicked Witch really. She was a Lawyer at heart - - do we have any Lawyers here children? A big boo for all lawyers shall we ?

1 … 2 … 3 … BOOOOOOOOOO

Ooh that’s better. Lawyers use the law that their friends made to take the Dental money too. Isn’t that nasty and spiteful children? BOOOOOOOOOO. We all know a bunch of baddies don’t we children? They are called the Dental Law Partnership. BOOOOOOOOOO!!

Things got so bad that an emergency council of Local Dental Committees was called. All the brave souls, they all got on their White Chargers [ Well, GNER , Cross Country Trains and the odd Porsche mainly] and rode to a secret meeting place – well actually a nice gaff in Cavendish Square conveniently underneath the offices of that nice Dr Lewis at Dental Protection.

He will look after you children.

The second half children is going to be very exciting. Shall we all giver a big cheer for Dr Mick and the LDC Merry Gentlemen and Ladies ?

Copyright

Load your quill pen. Cancel your Direct debit and write a cheque for £890 : for the GDC need your money in order for Mr “What is Regulation?” Moyes to stay at his club and for the GDC to employ dodgy research consultants while FtP is used for speeding dentists.

Maybe in contrast the steel gonads of the BDA, our illustrious GDC Chairman is actually somewhat more crystalline in his nether regions? At the recent Parliamentary Committee, his refusal to answer a BDA question was both intensely and deliberately discourteous. Mr Moyes' actions also revealed him to be far from the man of steel that is Dr Armstong.

So what does 2015 hold for us all financially?

In addition to the GDC tax what about £3500 for medico legal protection as a full time GDP ?

About half the CQC regulatory fee, pro rata across the profession so that is about say £300 if you take a finger in the air at the per chair sliding scale of cost.

You had better join the FGDP and read these documents the FtP Panels seem to think detail the clinical standard against which you will be judged. That will be £315 then.

Let’s assume you do wish to support your professional association - and they are now subtly steering you to the £795 membership.

No doubt a couple of essential interest groups will attract your attention – this is the membership you want to maintain - - let’s tack in £600 per annum.

Now you have to undertake CPD and you decide to go to days at which you can rinse £200- £400 per day. 15 hours of verifiable per year equates to 3 days in reality. Let’s budget £600.

So that’s about £7000 per year per dentist to go to work, before you start running the business. 10% of your income now goes out on the basics just to kick the door open at the office

Review your fees ... NOW!

A sobering thought matched only by the reality that in 2015, your fees need careful review.

And if you cannot review your fees because you work with a third party provider with a fixed system of remuneration, and a climate of remuneration clouded by austerity, you may wish to review that arrangement.

In these circumstances, the GDC hit of £300 is a simple pay cut.

As my kids say, get over it…

Me ...I'd rather get even and my memory is suitably long.

Watch out Mr Moyes. The profession is angry and none of your Chief Executive's banale platitudes will wash that away.

Copyright

Good morning worker bees. Get you cheque books ready. It looks like £890 is the scrap of ARF meat being fed to the lambs that are called the Council, led by Cruella deVil’s partner in professional fur-fights, Chairman Bill.

You should have all received yet another patronising diatribe from ‘er up top in which the choices are summed up as “Ignore your dentists and their fiscal stakeholder role in the GDC and keep the DCPs on side”.

You have three days. If you cannot be bothered, pay the price.

If you cannot afford this before Christmas, get lobbying NOW. You can see the GDC Council Members on line – mail them, let them know your feeling, for all things being equal, on Thursday you wallet will be shoehorned open by a large amount.

The Council must act with courage reject these options and simply ask that the Executive come back with a more acceptable solution.

Incompetence carries a price and it appears to be the order of £900.

Of course how you pay is up to you. There is a general feeling that you should cancel your DD.

I saw a comment that £576 by cheque and any increase by Postal Order, each sent separately and by Royal Mail Special Delivery which caught my eye. Mind you don’t get caught speeding; if the Magistrate hears it you will be up to the GDC for an FtP Party.

Ironic really that of course next year’s increase will have to cover the admin costs of this year’s collection.

Autumn has arrived, as has the rain. Time to close those curtains a while, light the fire and catch up with reading maybe? The fall is with us and that refer’s to Man U’s fortunes ….

Recently publicity should not have escaped your notice. Barely a week has passed since Public Health England, under the leadership of Dr Sue Gregory & Dr Sandra White went public on what many of us have known for a while.

12% of 3 year olds have tooth decay

Now … is that a scandal? You bet it is. But it is also an inconvenient truth that has been long ignored by Dr Gregory’s superior, the erstwhile Chief Dental Officer at the DH, Dr Barry Cockcroft. His new role has moved him downwards and outwards to NHS England of course. But it was on his watch that this problem both developed and was ignored. But it was on his watch that this problem both developed and was ignored. Was it not our illustrious CDO who hawked the Adult Dental Health Survey around as a triumphant scalp over the ne’er-do-wells, in full knowledge that he was ignoring the cries of ‘Fire’ from the coal face of children’s dentistry?

Just consider this secondary fact:

This is the first national survey of the oral health of 3 year old children in England.

Well that’s two scandals in consecutive soundbites– firstly the ignorance of the problem and secondly the lack of enquiring minds in the first place. What exactly have the DH been doing with taxpayers money might one ask?

The state of children’s teeth is now officially and very publicly worrying [1]. It was headline news on the BBC and even took lead coverage in the "Today" priogramme. The Public Health England report is found via the at the PHE website [2]

Do I not recall that much of all that we GDPs feel is wrong with the 2006 Contract is the UDA system of perverse incentives? The result of 10 years of perverse incentive is borne out by this report.

The Guardian highlighted the GA Admissions scandal in the early summer. [3]. This is quoted fromn The Guardian:

The number one reason for primary-school-aged childrenbeing admitted to hospital is to have multiple teeth taken out, newly released figures show….Provisional figures for the period 2013-14 show that 25,812 children from that age group have been admitted to hospital to have multiple tooth extractions, up from 22,574 three years previously.

Now it seems to me that Dr Cockcroft has wilfully presided over a collapse in children’s dental care with the 2006 contract and simply failed to undertake any attempt to resolve the matter. And believe me, he has been told many times.

We are to be thankful to Dr Gregory for her persistence in examining the problem. One wonders if there is a fundamental difference of professional approach to the job. On the one hand, Dr Cockcroft, riding the Dept of Health Fiscal Horse called Austerity, and on the other Dr Gregory’s role demonstrating true caring about the problem?

To any outsider there is a self-evident split, nay a cavernous gulf, between the opinions of the CDO England and the Head of Public Health England.

The rumours of efficiency drives allied to prototypes of Contract Reform abound. The GDPC is playing its cards close to its chest, whether rightly or wrongly. I for one think that they need to empower the whole profession with openness and transparency to call their MPs to account. Closed doors are a defunct way of acting as the profession's negotiators

What Sue Gregory has done, whether by intent or not, is give the GDPC an Open Goal to aim for!

If ever there is a problem that requires proper funding for dentists and their teams to work effectively, this is it.

The DH are now out on a limb, Dr Cockcroft has proved himself an anachronism, and Public Health England under Dr Sue Gregory has given reason and energy to the GDPCs position.

The GDPC must make their case without fail, and without shrinking from what can now be described openly as a 21st Century scandal of gargantuan proportions.

Like all football matches, the GDPC need us cheering them on - please open your doors, GDPC, and tell us your strategy. Let us know who is playing where, keep your fans on side.

Children’s dentistry in General Dental Practice is in a mess, and it is Dr Cockcroft and his political masters who shoulder the responsibility.

But it is dentists who can deliver the solution.

The GDPC know what they have to do now for negotiating a rejuvenated Contract Package and with it money to solve the scandalous problem of children’s teeth.

Take the Dept for Health [DH].
Add in an ineffective General Dental Practice Committee [GDPC] at the BDA
Keep the vociferous Local Dental Committees [LDCs] at arm’s length…
What do you have?

General Dental Chaos?

The other GDC and “The Referendum” are not the only kids on the dental block. The chaos of Contract Reform is still lurking in the periphery of our vision, and really ought to be a full on crisis for shouting about.

To those of you of a Gaelic disposition North of the border, good luck for the forthcoming shenanigans. By the time you read this Scotland might be heading toward independence if YES prevails – or toward much reduced dependence if the NOES have it. In some respects, our Scots colleagues have the best of all worlds – they have retained Fee For Service, and have a relatively user friendly Government. Any changes frankly are less than likely to cause great change or disadvantage in the short to medium term.

English [and Welsh] dentists on the other hand … From where I sit, the DH heads are still in the sand as we head out to a 9 year old discredited Contract with so many problems, it is laughable.

What with the GDC imploding and Scotland commanding our attention [the irony of a UK wide GDC trying to set an ARF on the day that Scotland may break away is not lost] it is easy to forget that in the background NHS England and the DH are trying to blag the next Contract Reform package
Increasingly, if you keep your ear to the ground, it appears that a Train Crash in slow motion is a suitable mind-set.

2015 not long now …

2015, people …. it is only next year – and what have we to show? Discredited pilots, great suspicion that the Corporates are trying to wedge the DH door open for personal gain, and a weak GDPC who continue to fail to nail down the critical issues.

The LDCs it has to be said are populated by wet fingered dentists who understand the issues. It is the LDCs who supposedly guide opinion at the BDA’s GDPC. Is that not what the LDC Conference is all about? Trickle-up democracy and all that?

And yet after all these years there is a feeling that the BDA’s GDPC is simply not taking the DH to task.
While opinion varies, there is a mood that the LDCs are passing water into wind when trying to influence the GDPC. If you would care to get that special ‘under the counter’ view of those in the know, you will find that there is a feeling that the GDPC are so desperate to see the present contract replaced that have forgotten all the headline issues that plague the current fiasco, overseen by the late PCTs and now NHS England’s LAT gate guardians.

Ask anyone, you all know it. The current problems abound. Whether it be the massive and unfair discrepancy in UDA values. or fairness in dealing with high needs patients – there are serious issues of finance. The clinical disaster of Endodontics is mirrored in the back office with HTM 01-05 and its fictional evidence base. What about Nurses and their enhanced professional status – no funding and no pensions! Status, indeed!!

Never mind the matter of practice sales or incorporation difficulties and how the CQC cope with it all.

Wake the GDPC up … NOW!

Now that the ARF is a matter closed in all but the detail, [OK so the GDC have gone running to KPMG in a panic and put the decision back 6 weeks – but are we fooled?] and while your antennae are still vibrating, why not turn some of your energy to the GDPC and their effectiveness in making sure YOUR contract is beneficial to you in 2015.

After all, if you want to pay your ARF and not simply take a pay cut to do it, you need Dr Milne and his GDPC colleagues to pull their collective bloody fingers out and to do so a bit quick. This next month or two is the last chance saloon before the Civil Service wrap it up for the election.

Time for the swarm of dentists to move along Wimpole Street. Even if you are NOT a BDA member – it is the GDPC who are gambling away your heard earned fees with their laziness and ineffectiveness at dealing with the DH.

You called the GDC to account.

May I suggest you ALL now call the GDPC to account. It’s your wallet that will pay for their failure.

Welcome back if you have been away. Isn’t it lovely to get back to the predictable routines of work after the manic family reunions on a beach somewhere?! Just over 100 days to Chr… Oops’ sorry, it’s the C word :) [1]

Have you got your cheque books ready? How old am I? Sorry, have you got your debit cards ready?

Unless I am reading the autumnal tea leaves incorrectly, the ARF will be heading up to dizzy heights in December. The brief storm of professional unity, demonstrated by the lightning strikes of letters to MP’s, the heavy rainfall of FoI requests to the GDC, the storm surge of letters to the Professional Standards Authority seems to have failed to break down the defences of the GDC Bunker.

The Chairman has been giving us the ‘Agincourt wave’ while the Chief Executive continues to see spending millions on a building upgrade while watching reserve funds drain way as a good way to go to work each day. Easy money innit?

What have we achieved, other than a smug sense of self-satisfaction? Anything? Anything at all?

The BDA have taken the view that the legality of the consultation is the weak point to aim for. We shall see, but I for one am hesitant to be overly optimistic on that front.

The phoney war of words, with the GDC threatening claims for damages upon the BDA suggest that if the BDA is to slug this one out, there will be a loser and the price of losing will be very heavy. Ironically the profession pays the legal costs of this stand-off either way. Any victory will look somewhat Pyrrhic. [2]

So to those of us simply plying our trade, it looks like next year will see a big rise on the ARF, and a big rise in indemnity costs. Oh for the heady days when the CQC were the bad guys! [3]

What does it take for a disparate group of headstrong entrepreneurial prima donnas such as dentists [for indeed that is what we are] to unite in action which WILL cause change in a gargantuan untouchable body such as the GDC, all fancy and dandy in their ivory tower?

Perhaps we need to swarm? [4]

Perhaps we can learn from our animals &insects – bees and ants, shoals of fish, herds of caribou, you name it.

Please do read that fascinating article on National Geographic. Here are some gems for you to think about:

•Honeybees have evolved ways to work through individual differences of opinion to do what's best for the colony

•How swarm intelligence works: simple creatures following simple rules, each one acting on local information. No ant sees the big picture. No ant tells any other ant what to do.

•The bees' rules for decision-making—seek a diversity of options, encourage a free competition among ideas, and use an effective mechanism to narrow choices

We need to understand that we do not need to know the big picture, but for our collective action to be effective we must act as a swarm. The history of our profession suggests that never have we ever acted in such a way. The history of the BDA confirms the difficulty they have had over the years firing up swarm or herd like behaviour.

Perhaps now, after all, we have started to demonstrate some features of a swarm. Perhaps we should hope that as the year peters out, we become an effective by all working together in a collective manner.

Perhaps then, the theory suggests, we will cause change at the GDC

The GDC can say and do what it likes to us as individuals, and indeed is doing so with belligerent arrogance. Government wrote their rules and there ain’t nothing we can do about it.

OR

As a united colony of dentists with swarm like activity.

This summer has seen a taster of what we can achieve. But everyone needs to play their part.

30000 angry letters to MP’s WILL count.

30000 angry letters to the GDC WILL count.

30000 angry letters to the PSA WILL count

30000 angry dentists arriving at the GDC on a chosen day to pay their ARF WILL really get their attention

100,000 letter from dentists and DCPs – now THAT will really get attention!

If you have not played your part, the swarm cannot work. If you have not written your letters, why not? It is a small act for all of us to act in the better interest of our "colony", the profession at large.

We need to reach that critical mass where not only do they listen in Wimpole Street but they also act. "Listening" in that "Quankeresque" manner is not enough! If there is a role for the BDA it is to develope the dental swarm.

Get buzzing boys and girls, we are not there yet. This battle is far from over, but it is also far from won.

If you think the meteorological heat is oppressive, you want to try working in Wimpole Street. AirCon does nothing to relieve the heat of the pressure the GDC should be feeling.

What interesting, perhaps desperate times we live in.

The world is awash with wildfire wars with all the suffering that ensues. The state of children’s teeth of those who do not ‘get’ the dental health message in this country remains an unresolved scandal. Contract Reform of NHS Dentistry in England has become a fictional event of the future. The CDO England must be playing a lot of golf these days because there is naff all else going on. Dento-legal indemnity has started to rise in cost alarmingly as the GDC and it’s woeful Fitness to Practise regime comes off the wheels.

But it takes a proposed rise in ARF to really galvanise the profession in a unanimous outpouring of anger.

Well directed anger?

This is being expressed in many ways – letters to MP’s, the professional Standards Authority, letters to the GDC allied to Freedom of Information requests to name but a few. At meetings, the conversation is grim and consistent – it’s the GDC innit?

Even our old muckers the BDA have bared some teeth which, to judge by their public statements, are finally sharp enough to threaten injury.

What is happening so far can be summarised as a collective professional rant. There is nothing wrong with that. This process of ‘ranting’ is a precursor to something much more effective

It is well know that RANT is actually an acronym

The RANT acronym

Review your position

Analyse your options for Action

Notify interested parties of impending Action

Take action

Where are we?

I think we are heading out toward the last element, if only driven by the timescale.

A request for legal review, a BDA driven legal challenge, and protesting by payment in cash at the front desk of the GDC are just some of the actions being proposed. What about resignation of a significant cadre of the dentists they need to make the processes and systems function?

What about calling for the resignation of the Dental Professional GDC members en masse? It certainly seems to have merit.

Will the ARF be less than proposed? My money says “yes”

Will we see heads roll at the GDC? The CEO, Ms Gilvarry for example? Its hard to see how her position can possibly remain tenable. She certainly has lost our confidence, but I would imagine the GDC staff are pretty low as well.

What about our new appointed Chairman, Mr William Moyes? His condescending e-mail to registrants allied to his Pendlebury Lecture suggest a level of isolation and ignorance that make you wonder how he ever got the job. Based on his utterances so far, he simply does not get it. Based on the lack of communication by the GDC’s Dental Professional members, I thinks its safe to assume the GDC has battened down the hatches and GDC Council Members are prevented from public comment. So much for transparency. The ARF was not even an agenda item at the GDC Council meeting of 24 July.

Problem? What problem?

The GDC have absolutely lost the confidence of the profession. The have proved themselves to be the most incompetent of Regulatory bodies, and they are asking us to pay for their ineptitude.

The short answer Madam Chief Executive and Mr Chairman is “NO – NOT ON OUR WATCH”

You fix your problems first and we might talk then .

Until then, we will continue with the biggest professional RANT seen for many years.

Once again I profess my grateful thanks for the GDC’s role in uniting the profession, finally.

Enjoy your break people. Be assured, the heat will still be turned up when you return.

Like many I am grateful for the services of the GDC. I pay the ARF secure in the knowledge that my patients are safe and the money well spent.

Presently though I feel I have more to thank them for than usual. I hope my readers understand irony ...

Professional disunity?

Just when the state of the dental profession cannot look more perverse, the GDC have achieved something that the last 8 years of the DH and their man at the helm of the 2006 UDA disaster has failed to cause.

Numerous LDC Conferences calling for this and calling for that – the ever calm and serene profession of dentistry has just adapted and carried on.

Implosion at the BDA and barely an extra glass of claret was supped at the ripples on the water of our profession as calm discussion took place about politics.

A raft of daft changes came along such as the UDA system, the HTM document, the OFT report you all now the form – and we ranted for a few months but quietly took another blow to the body, absorbed the costs and “moved on”.

The public acknowledgement that the Contract Pilots have been a sham and that any changes to come will be merely prototype in nature and at least 2 years down the line. Dentists have had a bit of a cough to their colleagues and carry on, “being busy”.

The dreadful farce of Foundation Dentists lacking places allied to their debt and many were heard to comment widely and indeed care deeply, but the rump of the profession have likely returned to their skate-like lying on the bottom. “They’ll get by” we all thought. “Wouldn’t recommend it to my chidren” we muttered. Next please.

The CQC came over the horizon brandishing a large bill and a lot of empty folders and by and large we have paid the charge and filled the folders, only to carry as before doing what we do – meeting, greeting, interacting with & treating patients with their range of ailments and fears.

Incoming, incoming ...

But the GDC, in their proposed hike of the ARF to £945, allied to a comical consultation so pre-determined as to be reminiscent of a past communist regime have caused the profession to both awaken and threaten to unite in a way never seen before.

Just when it was looking very interesting, the satellite of the GDC, the Dental Complaints Service fire their own salvo at the profession. The DCS may be “at arm’s length” and independent or so they claim – but they are wholly funded by the GDC, ergo our ARF’s – so how independent they are is, shall we say, somewhat debatable.

What effect was intended, I wonder when the DCS took a full page advert in the weekend colour magazine of the Daily Telegraph claiming to act on anything less than COMPLETE satisfaction for every patient.

I have a three letter acronym of my own - FFS!!

Professional unity?

Never in 35 years have I seen such united sentiment and anger, perhaps however more importantly associated with individual response and action. The electrons are red hot with e-mails, complaints and letters to MP’s and these bodies. How ironic that when a patient complains about us, we are always assumed to be in the wrong. When we complain about these bodies, they are always correct and indeed learning. Is it just me?

So, what now?

Well this is an unprecedented time, and it will call for unprecedented action.

Perhaps a mass sentiment requires a big organisation to coordinate a big response. There seems to be a widespread sentiment that the GDC has lost completely any confidence it may have had with the profession. Of course they will blandly point to some piece of biased research they did to show how well regarded they are.

They may not realise but the rules have changed and the gloves are off. Big boys games demand big boys rules. And it is the GDC and the DCS who started this.

Who will rid us of this poison organisation, who will deal it a fatal blow, for it is a big monster and well protected by the armour of politics?

We must thank the GDC & DCS – the profession appears to have finally awoken, and if I am not mistaken, this time it is getting to its feet.

Interesting times with a little smoke of excitement. Who will wager what we see next? I won’t!!

What is about the field of dentistry that there is a pervasive feeling of being a witness to abuse of a gargantuan scale?

GDC abused ...

The GDC is ignored in the Queens Speech – and the massive costs they are incurring in the FtP processes will remain, unless a Section 60 order can be obtained. All we need is for those creatures of honour and selfless behaviour, our elected and appointed politicians, to get off their collective backsides, but no. It’s all too much. No wonder the GDC feel abused.

LDC's abused ...

What about the LDC levy fiasco? All it needed was for someone to actually care about writing the software properly, but No, NHS England could not give a monkey’s, and instead of admitting their error and correcting it simply piled abuse upon the LDCs by forcing through extraordinary change at no notice at a time of either massive change in reality [creation of NHS England and LATs] or proposed changes coming down the road [Contract Reform]. What did LDCs do to justify such abject abuse?

Pilots abused ...

The pilots it seems are a sham. It is an open secret that the methods of practice will not be in any new contract and as many speakers have observed it seems likely that all that will happen is a sort of unset fudge of RAG-UDA system will emerge – your practice will be paid less to do more and yet expected contractually to do everything. And while you are about it, why don’t you walk around with a knife in your back, engraved with the CDO’s initials as a gentle reminder that you are getting paid for such abuse.

Children abused ...

And then we had the ITV Programme about Dentists following on from Dr Kilcoyne on Radio 2 last week. The low voice, the clichéd descriptions of dental visits and experiences.… Ms Dodgy-mum is filmed celebrating her distressed child’s GA for multiple extractions as though it is a medical ASBO. No, it is child abuse and you are not fit to be that child’s mother.

The lack of caring by a cadre of parent s as their children experience destruction of theirteeth with the pain and misery that accompanies it - now THAT is abuse.

Time to move away from the muckspreading?

Sadly, abuse is widespread it would seem. OK, that’s why we go to work, to help do our small bit to reduce it. But for goodness sake do not stand in the way!

With the help of our vocal colleagues and representative bodies, it’s time to start calling a spade a bloody shovel.

The state of day to day dentistry at the diseased end of the social spectrum is in crisis and nothing that our illustrious CDO and his Machiavellian contract changes are lining up seem to have anything to offer to start work on these issues of national importance. Our very social fabric is threatened by the continued dental disease that is prevalent.

You know what? I think suddenly dentistry IS massive election issue. Let’s go and abuse some politicians for once.

Welcome back from the long weekend, now just a few weeks to run and you can all zip off to the sun again

Monday was perhaps the new Independence Day, as the Euro results poured in. I worry that this word 'Independence' is being politically hijacked

So: Are you independent of mind and decision? Really? Truly?

The EU elections this weekend have thrown three major GDPUK topics into a shaft of light.

Those of you who gaze from a distance at the sheer energy of some of our more vocal members will have notice three threads of great length. One touching on that supposedly untouchable subject, matters of belief and faith, while another has been exploring the issue of the Scottish vote on Independence due to take place later this year.

Combined with the now famous histrionics of the orthodontic thread, you would be forgiven for having pressed the ‘snooze’ button.

So wake up at the back. I want you to answer a question for yourself. What does being independent mean to you?

Mr Farage is celebrating scoring some points in what is normally a three horse race, by arguing for the UK’s independence, and arguing against the £12Bn net spend to the EU every year.

As dentists, we pride ourselves on being independent – in practice, in thought and in action.

Ask 10 dentists a question to which the answer is Yes or No and you will get 20 different answers.

But are we independent? Really? Truly? Where is the fine line between that and bloody mindedness?

If you practice under Government funding in any of the 4 parts of the UK, do you really feel independent? Or are you reluctantly beholden to how someone else wants you to help and practice dentistry for your patients against your better instinct??

If you are in private practice, are you one of those for whom the next big case is always the one to clear the overdraft? Therefore you are always on the lookout for some poor soul to benefit from your great skills? Or perhaps you feel you cannot practice good dentistry because of a limited private capitation funding stream not of your making?

We even have this long abused concept of Independent Practice, as though “Private Practice” could be rude and insulting perhaps? Will the BDA rinse that off for the next batch of unknown NHS England contract changes, I wonder?

Perhaps independence of thought and action is actually impossible without feeling pressurised or being selfish.

Cooperation over independence?

What dentists are masters at is cooperative action. We run or work within highly efficient micro businesses and at a moments notice we can adapt and cooperate with whomsoever requires our skills and time. The CQC roll into town – we change and adapt. A patient arrives – we change and adapt. New staff requirements develop - we change and adapt.

Long may this be the case because with EU and Scotland and a General Election, the next 18 months are going to be interesting.

That old French phrase has come to life. Plus ça change, plus c'est la même chose.

Strangely while everything around you seems to be up in the air, it takes a very strong sense of independent spirit to simply wind the windows shut and focus on your patient needs with one hand while with the other you change and adapt

What's in an Acronym? CR in the current climate is not that jaw relationship that is so critical to dental function.

Politically it is destined to be Contract Reform.

But maybe it should be Contract Rejection ...

The sands of dentistry and its politics often shift with the tides of time and events.

I am sure many of you share my frustration, often palpable profession wide, that the BDA often seem to be in the stuck in the wet sticky variety, making little inroad to the wider landscape of NHS Dentistry.

Well, all of that has changed. Suddenly dentistry and the BDA is running on the beach and it is the DH and NHS England [and inter alia the other NHS authorities] that are dragging through the sludge.

First we have the election of Dr Mick Armstrong to the Chair of the BDA’s flagship Professional Executive Committee. At a time when we need people who will call a spade a spade, this man carries a Northern reputation for using the thing to whack his message in if necessary. [1]LuvverlyJubbly.

VT Pay Cut now

Then the DH published its “Dental Contract Uplift and Efficiencies 2014/15" information [1] [2]. It would be fair to say that to lead with the word “Uplift” is backspin indeed worthy of any Minister.

And two items hit dentists between the TMJs.

Firstly, just when it cannot get any worse for some of our younger colleagues, their starting salary has just been chopped by some £2000pa.

Secondly 4% cutsefficiency savings are being projected onto NHS Dentistry.. The invisible ink suggests that there will be more to come in the next parliament. The DH have not finished yet.

GDP Pay cut next?

Now if we assume that your practice profit margin in your practice is say 30%, and if we assume that in the real world , your employment costs and overheads are inexorably on the rise [and DON’T look at your materials bill !!] we must conclude that the 4% will come off YOUR take. So if your profit margin reduces to 26% that equates to you, the business owner, risk taking dentist being offered a 13.3% pay cut to run with the Contract Reform package.

Nice.

Now add to the toxic brew that is stirring the news from Lloyds Bank and their specialist market research that dentistry is now amongst the most confident in the development of Private Practice [4] [5] [6] … Really? Well, quelle surprise !

Contract Rejection?

CR are the letters that will absorb much of your thinking processes in the next year. Contract Reform is being piloted near you and the new methods of working are in themselves more than a cause to focus the mind.

Now ask yourself: Do you really want all that hassle for a pay cut?

Now ask yourself if these projected circumstances are likely to make you a happy bunny, offering your patients the best of modern dental care appropriate to your circumstances?

Maybe the acronym “CR” actually will come to mean Contract Rejection.It sounds like one of the professions leading banking units thinks you are not alone and that you do have the confidence and ability to make it happen.

SS BDA – off the rocks?

As the BDA begin their conference with a superb weekend of dental derring-do, I suspect like many I can think of no better leader than Dr Armstrong to conjure the words that will tell the Government where to take to their Contract Reform and indeed where to stick it if their attitude remains so brutally cavalier.

Its not just meteorological Spring sunshine you can feel. The profession suddenly is starting to shine.

Have a joyful Easter and if the Conference is your scene, may all your conferring be about the positive future. May your personal CR be unaffected by all this fuss about ... CR

There was a hard frost this morning – a chill in the air of you will, and not entirely meteorological in its origins. Not the first of the dento-political winter, I'll be bound.

Anyone in NHS practice will knowof the work of the LDC’s in representing colleagues locally, in a voluntary manner, giving generously of their time. The annual Conference of LDCs is where opinions are aired and motions passed that, one hopes, do cause the BDA's GDPC to sit up and take note. All of which feeds in to negotiations with the DH’s various.

Now I am not naïve.It’s not a perfect world and sometimes you can get the feeling that any attempt to shift an entrenched DH position is akin to pushing a wet noodle.

But the representation and the collective voice are a critical part of the complex relationship with the rule-making paymasters in Whitehall.

One anticipated problem that is emerging is the funding of the LDCs.

Gone, under the 2013 NHS changes, is the simple local Statutory Levy, delivered locally to the relevant LDC. That worked far too well and was far too easy.

In its place – well to be honest, it is unclear. It appears from information available to date that the LDCs are being asked to suddenly and without notice combine their banking facilities. The idea of a local levy seems far too much effort for the Area Teams. Indeed it is not even clear about the agreed method of calculating a Statutory Levy. Worryingly, much of the wording that Area Teams work to involves the use of the word *may* - it is not even clear if they *must* collect and distribute the LDC Levy on your behalf.

The Area Teams report that their position is the one recommended by NHS England. Which unless I am very much mistaken, means that the CDO at NHS England presumably has rubber stamped this approach himself.

Bad management or a good plan ? ...

Now call me suspicious.It is but one year before a huge contract reform which will catch the unwary and unprepared with significant changes to their style and methods of practice. This will in turn create a cadre of vulnerable practitioners who simply cannot make headway under the new regime and will need effective representation. One arm of the representation will be the LDCs. This would the very same LDCs who are about to be put through the enforced political shredder of unexpected reorganisation themselves. You don't think that is could be a deliberate intention on the part of the CDO and his cohort of "Contract Reform" planners, do you?

If the BDA have woken up from the spell of scandal with the magic kiss of Dr Mick Armstrong, he and the GDPC would do well to make a very big fuss.

In the big game of dental chess, I worry that the DH are in a very strong position. An effective FULLY FUNDED LDC is in YOUR interest.

I suggest you start making yourown fuss while there is time to prevent the matter worsening. You could start by phoning your LDC Rep and offering your support and also phoning the BDA and enquiring, politely if you will, what exactly they are doing in the Trades Union role to sort this true scandal out?

Those of you who are still ave dwelling after the wettest winter on record may have missed the strong discussions on GDPUK regarding a US development in Fixed Orthodontic mechanics.

Wake up at the back …. Ortho fills diaries … You might say it whets your appetite as opposed to your gardens.

There is a fascinating shift occurring in Orthodontic practice in UK Dental Practice.

For much of the profession, ortho remains the remit of a local specialist. For a significant cadre however, the skills and learning required are well within the grasp of a competent GDP. Indeed many specialists with a teaching bent are want to publicly encourage us GDPs to take up the baton in a responsible and measured manner.

But …

There appears to be a rapidly strengthening sense of threat.

The specialists are feeling threatened by the GDPs marching across their patch, and the not-long-past British Orthodontic Society advert in a national broadsheet ruffled more than a few feathers. The GDPs are thinking this can’t be all that difficult and are starting to strut their stuff on this fertile ground for business – after all, every year another cohort of young patients pop into your sights.

So how interesting it is, then, to observe on one side of the vested interest fence we have Dr Viazis and the Fastbraces® brand becoming the torch of vocal GDP protagonists, to the evident irritation of many.

On the other side of ethical glass screen see how Align Technologies & Invisalign® are quietly starting to insert themselves into the postgraduate teaching programmes, in manner of poacher-turned-gamekeeper, and are now part of 7 centres in the UK

Influence, Sir? That'll cost you ...

We have always known that money buys influence. How you use that money determines how effective your influence might be.

Orthodontics appears to be a good example of the same desire to apply money and buy influence having opposite effects from differing companies.

As a GDP, if you are doing ortho, it’s Caveat Emptor. Dark forces of corruption lurk, seeking to separate you from your money and are not far beneath the surface.

Cynical? Qui , moi?

“Come along there, move along please, another QuickBuck will be along in a minute.”

Nearly all men can stand adversity, but if you want to test a man's character, give him power.Abraham Lincoln

Ok its crunch week, and the quote I have used here seems apposite to the issues at stake in Wimpole Street this Friday, 21st Febrary.

The Probe carries its coverage of the Big Lie discussions which carry on from Dr Kilcoyne’s leading campaign . The letter in the Daily Telegraph stirred the waters.

The effect of The Probe is to relight the fires of this burning issue in a very welcome manner. The consistent spin of the official replies is becoming eye crossing.

There is general worry that the tripartite comfy zone that is the table around which the BDA, the DH and NHS England sit is looking increasingly as though it is actually a defensive set up to protect their interests, at the cost the care of the patient by dentists.

And so this Friday, as BDA Members YOU have a chance to make YOUR voice heard.

If you cannot attend this EGM, please ensure you vote by proxy. Crack on now because it is a carefully defined legally binding process. You cannot just phone a mate the day before.

Now is the chance to fire up your Representative Association. Put a rocket up their collective arses if you will.

There will not be a second chance before Contract Reform hits you between the eyes.

First we have a BDA EGM on the cards. Anyone who reads tea leaves must be thinking Friday 21st of February is the new Ides of March. While the BDA turns in on itself in what some might see as a death roll, the world moves on and, boy, how fast!

The DFT numbers have been formally announced – see the link – and the big picture? 1 in 5 students have not got a job to look forward to – nice motivation if you can get it – NOT! Approximately 240 out the UK Graduate bag of about 1100 have been ‘placed on a “Reserve List” I say approximately – the numbers are not entirely clear even if the big picture is. What’s that – about 10% in the end? well, give or take.

Have we all been witness to a Coup d’Etat in dentistry – CoPDenD have quietly become the most influential body in dentistry. If you are a student on the receiving end, it must feel like a very unfair and cruel arbitrary selection process.

You know what sucks? It is clear that CoPDenD would have you believe that the NHS and it’s public funding is the only kid on the block. They saw off Private Vocational Training and now have a monopoly grip on the peri-graduation phase of ones career. Is it me or does CoPDenD have a funny smell around it?

The size of the private dental market is now likely bigger than all of the NHS dental funding for dental care, both primary and secondary.

So why is there not a flourishing private-public partnership in dentistry in which the shortfalls of NHS funded DFT are more than taken up by a commercial organisation? If ever an opportunity for the FGDP to do something practical ever has been missed this must be it. I’ll bet if SERCO or Compass were bidding, Private VT would be up and running by now.

And now ... midway though a Manpower Review at the Higher Education Funding body… the word on the block is that a blanket 10% student cut across the board has been enacted with immediate effect. The Twittersphere is lighting up this week as the well hinted cuts are finally publicised.

Perversely, that actually sounds like some form of a solution. Fewer graduating dentists are an inevitable consequence of reduced Government funding. Since we all know the Government IS broke, maybe this 10% cut will be in ADDITION to the chopping of two dental schools, which is being widely trawled.

That will in 2 years mean a broad reduction of about 270 students per annum - job done, CoPDenD’s DFT books balanced.

But where is the drive to use the vibrant private market to create educational opportunities which support and supplement the NHS funded basic training? Lots of willing weekenders but no structure.

In its small way, dentistry is now witnessing the effects of lack of public funding. If the profession of dentistry is a thermometer for public finances, the mercury is falling. So be it. Can’t spend what we don’t have. It is not entirely unexpected after all

But there is a £7Bn, and growing, private market for dentistry. In fact, year on year growth of 10% and more is anticipated.

There has to be a better way. The big picture of publicly funded dentistry is gaining a degree of focus. We need to ensure that private dentistry builds its own big picture, and fast.

How? By whom?

Questions a’plenty. Answers on a postcard please! If 10% of you reply…

2014 is developing as quite an interesting year if January is anything to go by.

Check your straps Mesdames et Messieurs. The ride is getting rough.

For a public letter to have any onward effect, a body of opinion must develope into an irresistable call for change.

ITV's Daybreak in fuelling further the debate produced contrasting performances. The passion of Tony Kilcoyne winning hearts and minds was evidently enough for wee Lorraine ... But the seat shuffling discomfort of John Milne was sadly not the supportive powerhouse that the profession needs from its leadership. Maybe he needs to get off that fence. The BDA's PR release, reminding us all of the power of the pilots, suggests that you can kick the GDPC's door down, but the deals are already being done for the new Contract Reform.

If GDPUK is anything to go by, there most certainly is a developing momentum.If the lack of response from the DH, robust or not,is as deafenaing as such political avoidance would normally be considered, I think it fair to say that Dr Kilcoyne and his band of merry men may have found a weak point.

So what's in the pot, cooking at this time?

We have the demand for DH honesty about what is or is not available under the NHS - if mixed practice is to continue, definition of the boundaries and rules is a must - a deal breaker if you will. Austerity measures in wider Government surely mean the timing is right for a properly defined basic service. It simply cannot be anything else.

We have the terrible scandal of Foundation Training and the lack of availability of places - only this week we read a powerful comment on GDPUK from a graduate colleague who has fallen foul of the CoPDenD Stasi for a second year. Given the EU regulations, Foundation Training as a compulsory requirement must be dead in the water surely?

on an aside, apparently the GDC think the the NHS is the Gold Standard. Yes I splutterred into my cornflakes too!

Here's Version 1 of the shopping list then:

A defined core service for NHS funding

A clearly defined set of limits to permit the business of dentistry to have mixed income streams, the NHS being one of them

Scrapping of the discriminatory NHS FD Training requirement and the National scheme, and wind up CoPDenD

Happy New Year y’awl. For those long-breakers among you, welcome back to the coal face, and the dark days of gyms, diets and abstinence. Not long now and it’ll all be chocolate!

And boy, has the dust been a’disturbed in your absence.

You see... "the letter" is out. See the link below if you wish to read it, and read it you should. The cat is out of the bag but is there a mouse to be caught? The gauntlet has been thrown down, but will the DH accept the challenge or merely hide under the armour of political expediency? You decide - and if you choose to act, just maybe you will.

So what?

Will anything change? Only if you truly believe with a passion in your profession. Only if that passion is strong enough to make you feel you want to change something. Only if you can be bothered to make your voice heard at the GDPC. Only if you call your MP to account. But please do NOT do nothing.

If it was a table tennis ball, it would be an unplayable serve with all the controlled spin! Although, to give the DH credit they “try” to collect “factual data” and are referring to the said data in what might be described as a strangely neutral way.

As denials go, a wet kipper thrown from 20 yards would have been more effective. Perversely encouraging I think. Anyone might think the CDO has been awaiting this challenge for a long time.

What now?

Dr Tony Kilcoyne , with his boundless energy and commitment, has highlighted two major issues which the DH and inter alia the CDO England refuse to address:

Ask yourself: what can you do to move the DH start their road to better ways in 2014, by admitting these two truths publicly:

1. The NHS Dentistry System in England cannot possibly provide for ALL the clinical needs of ALL their population fully.

2. The NHS Dentistry System in England cannot possibly provide ALL clinical care & treatments to the highest standards available, for all their population too.

I say again - what now?

As the quiet lurking kinda readers who are happy being below the parapet, I think there is a job for you here.

If you agree with the essence of the argument here, tell your patients. Let them know YOU care about them and what the Government system does to your practice.

If you agree that we need a proper definition of what IS available under the NHS and what is NOT, call your LDC rep. Unless of course you remain content to see your mixed practice options shrink back again ...

E-mail John Milne at the BDA GDPC

and copy all correspondence to Dr Barry Cockcroft, CDO England.

Having opened the can of worms, we do now have to stick our hand in and clean the can out. In my opinion, we have until the end of March to achieve the changes needed for the 2015 Contract Reform.

1. The Francis Report – Chairman states:"They (patients) were failed by a system which ignored the warning signs and put corporate self interest and cost control ahead of patients and their safety.”http://www.midstaffspublicinquiry.com/report

4. Dentistry planning is only based on ‘visible’ obvious decay holes in major surveys. This is totally inadequate by NOT using modern techniques for hidden decay detection between teeth like X-rays or other detection methods. Such survey results or conclusions are thus unreliable and invalid for planning.http://www.dhsspsni.gov.uk/adhtechnical_information.pdf

Is it me? Has the pace of prospective change suddenly become turbo-charged?

It is worth reminding the profession and its representatives that by and large, in GDP we are NOT employed. We are independent contractors. So why do the DH and our academic colleagues keep trying to treat us as though we are their whipping boys.

If you are an associate, I reckon you might be worrying about the lie of the tea leaves. Ever fancied re training as a Therapist?, Sorry to say , but it might be a good investment.

If you are a practice owner, under the NHS, the Ides of March 2015 look an ominous date. Your business is dependent upon Government funding; you are NOT employed and yet you are being treated as an employee. Is it really worth the [soon to be emasculated] pension?

As a private practice owner, are the Government REALLY going to impose rules to eliminate your freedom to practice the way you see fit? You have the freedom to plan and the capacity to respond. But there are massive changes a’coming. Bone up ... you have been warned.

In no particular order we have

· The CDO stating that NHS dental care will continue to be an unspecified [and ergo unlimited] commitment.

Piltos continuing to point to disastrous Patient Charge Revenue allied to the "It can only work with Therapists" big picture.

· Suddenly there is a proposal to break up the skill base for GDP into “Tiers” – and as many are already wondering, with associated ‘registration and accreditation’ costs. Allowing Quangocrat driven deskilling is by any description professional suicide.

· The Chairman of the GDPC starting to play some cards as the negotiations continue for “Contract Reform”.

· There seems to be a groundswell of academic attempt to wield influence over the activities of GDPs –from Prof Steele’s changes underway to Dr Chate at the RCS Edinburgh starting to flag GDPs activities in simple orthodontics

Well, I might be a cynical old git, but I reckon the Dept of Health horse has probably already bolted. I think it highly likely that we are about witness a pre-planned move to the date of Contract Reform. Standby for change and press releases on a quarterly basis. Standby for the BDA being outflanked and out-manoeuvred as the soul of dentistry is once agin under threat. Having a Big Stick is of no use against an out-of-reach elephant.

I reckon the purpose of all this phoney consultation is simply to drag the profession along with a mouldy carrot.

If, as a profession we do not like what Prof Steele’s changes are presenting, and do not think that these changes will either benefit our patients or our businesses, and our associate colleagues, we have a duty to act.

We have a duty to say NO.

The BDA has a duty to say NO

We have a follow on duty to carry our patients with us in this Brave New World.

Its looks like Christmas 2013 will be line-in-the-sand time folks.

Which version of Brave New World do you want to be part of? The Government’s or your own?

Do you want someone else whipping you at their pace or do you want to control how your career and business evolves?